Great teachers. Great education. Great opportunities.

Application for Enrolment

Student details

(Block letters please)

Family Name
Male

Female

Given Name(s)

Preferred Name Date of Birth

Religious Affiliation (IF ANY) Nationality

Year Level Applied for (eg ELC4 3 DAYS, Year 7) Year of Entry

Present School or Present Preschool Centre

Any Previous Schools

VICTORIAN STUDENT NUMBER (VSN) (if known)

Is your child
a temporary resident of australia

An australian citizen
yes

no

Yes

no

If yes, please provide supporting documentation

yes

no

yes

no

indigenous/torres strait islander

a permanent resident of australia

If yes, please provide supporting documentation

DOES THE CHILD HAVE ANY MEDICAL CONDITION OR SPECIAL EDUCATIONAL NEEDS OF WHICH STAFF SHOULD BE AWARE?
iF SO, PLEASE GIVE DETAILS*:

Connections with Yarra Valley Grammar

Current family connections with Yarra Valley Grammar (eg brother, sister, cousin, etc)
Name and relationship

Year Level and House

Past family connections with Yarra Valley Grammar (eg father, uncle, mother maiden name)
Name and relationship

Final Year at YVG (eg 1990) Year Level (eg Year 12)

House (Annells/blue Arnott/red Hughes/yellow Plummer/green)

*P
 lease note: any medical conditions or special educational needs must be known to the Principal prior to enrolment in order to ensure that an appropriate program can be offered.
This may include access to recent school reports and any professional assessments relevant to the planning and resourcing of an appropriate education program.
Reports and assessments will be treated confidentially by staff, and according to the Schools Privacy Policy.

Parent/Guardian details
Student resides with:

Both Parents

Mother

Father

Guardian

At this address

Postcode

Home Telephone Home Facsimile

PARENT/GUARDIAN 1
Family Name Title (Mr, Dr, Prof, Revd etc)

Given Names

Preferred name

Address (complete only if different from child)

Telephone

Occupation

Employer/Company

Business Address

Business Telephone

Facsimile

Email Mobile

PARENT/GUARDIAN 2
Family Name Title (MrS, MS, Dr, Prof, Revd etc)

Given Names

Preferred name

Address (complete only if different from child)

Telephone

Occupation

Employer/Company

Business Address

Business Telephone

Facsimile

Email Mobile

Declaration by Parents/Guardians
We request that the above-named student be registered for admission to Yarra Valley Grammar. We have read and noted the Conditions of Enrolment.
We jointly and severally agree to abide by these and any regulations from time to time in force at the School and to pay all fees and other monies falling due to the
School in respect of the student enrolled.
We have read and understood the Privacy Policy and, in making this application for enrolment, consent to the collection and disclosure of personal information and sensitive
information as provided for by the Privacy Policy.
We will advise the School in writing of any changes to contact details or information in this application.

THIS APPLICATION REQUIRES THE Signature of both parents/GUARDIANS

PARENT/GUARDIAN 1
Name Signature DATE

PARENT/GUARDIAN 2
Name Signature DATE

Credit card payment details

Credit card details

(Please complete THE FOLLOWING details)

Card type

Payment for
$55.00

Application (inclusive of GST)

Visa

Mastercard

Card number

Name of student
Expiry date
/

YEAR LEVEL APPLIED FOR YEAR OF ENTRY

Name on card
Name of student

SIGNATURE
YEAR LEVEL APPLIED FOR YEAR OF ENTRY

Name of student

DATE

YEAR LEVEL APPLIED FOR YEAR OF ENTRY

CONTACT PHONE NUMBER

NOTE: A separate signed application for enrolment must be
completed for each student.

OFFICE USE ONLY

Application Fee Receipt No.

Birth Certificate Enrolment Charge Receipt No.

Conditions of Enrolment

Privacy Policy

(THESE WILL APPLY IF YOU ARE OFFERED AND ACCEPT A PLACE AT THE SCHOOL)

1.

The School collects personal information, including sensitive information,

about students and parents/guardians before and during the course of a
students enrolment at the School.

2.

Sensitive information includes health information (in the form of medical

reports or otherwise) about students within the terms of the National
Privacy Principles under the Privacy Act 1988.

3.

The primary purpose of collecting this personal information and sensitive

information is generally to enable the School to provide schooling for your
son/daughter, and to enable the School to discharge its legal duty of
care. The collection of some information by the School is required by
law, including but not limited to laws regulating public health and
child protection.

4.

The School from time to time discloses personal and sensitive information
to others for administrative and educational purposes. This includes to
other schools, government departments, medical practitioners, and people
providing services to the School, including specialist visiting teachers,
sports coaches and volunteers.

5.

If we do not obtain the information referred to above, we may not be able

to enrol or continue the enrolment of your son/daughter.

6.

Personal information collected from students is regularly disclosed to

their parents/guardians. On occasions, information such as academic and
sporting achievements, student activities and other news is published in
School newsletters, magazines and on our website.

At all times the School reserves the right to select the students who
attend the School according to the School policies as varied from
time to time, and as communicated via the Principal.

2.

Parents/guardians must divulge, with appropriate documentation, all

relevant details regarding medical or other conditions that may impact
upon the Schools ability to properly care for the student, and to enable
consideration of any extra services and facilities that may be required.
Such information must be based on all current information available to
the parent or guardian at the time of application.

3.

During the period that the student is enrolled at the School, parents
/guardians must, as soon as practicable, bring to the Schools attention,
with appropriate documentation, any new medical or other conditions
affecting the student that may impact upon the Schools ability to properly
care for the student, and to enable consideration of any extra services
and facilities that may be required.

4.

It is a condition of the acceptance of a place offered by the School

that the parents or guardians agree to be bound by the Schools Policies
as varied from time to time and promulgated by the School. The School
reserves the right to impose any other disciplinary action that the School
deems appropriate, or to expel or suspend any student from the School on
the grounds of unsatisfactory conduct or performance, failure to obey the
School Rules, Discipline Procedures and Policies, or for other reasons.

5.

Students of the School are required to take part in all School activities
such as sport, music and performances, including those scheduled out
of normal school hours.

Application process

6.

Fees and charges are subject to amendment by the School Board and
are payable in advance, ie. within fourteen days of receipt of account.

PLEASE RETURN:

7.

The School reserves the right, which may be exercised at any time,
to refuse to allow a student to continue their education at the School
while any fees remain unpaid. Only in exceptional circumstances,
at the discretion of the School Board, will a student be allowed
to enter a new term if the fees of the previous term are unpaid.

(i) This Application for Enrolment

(completed in full and signed)

8.

If one terms notice is not given in writing before removing a student

from the School, a terms fee in lieu is chargeable.

(iv) The application fee of $55 (including GST)

9.

The Principal is authorised by the School Board to take such steps

as he/she may find necessary, on behalf of the School, to recover
unpaid fees.

to: Admissions and Marketing Office

10. Where there is more than one parent/guardian of the student at the
time of enrolment, all parties must sign the Application for Enrolment
form and accept these Conditions. It is understood that all parties to
the Application for Enrolment form will be jointly and severally liable for
payment of all fees and charges levied by the School from time to time.

(ii) A copy of the Birth Certificate or Extract of Entry

(iii) A copy of the latest school report (if applicable)

Yarra Valley Grammar

Kalinda Road
RINGWOOD VIC 3134
AUSTRALIA
NOTE: To ensure our records of your childs enrolment are correct and up
to date, please notify the Admissions and Marketing Office of any changes
of address or contact information.

8712 04/12

1.

Great teachers. Great education. Great opportunities.

Marketing information
YEAR LEVEL APPLIED FOR

YEAR OF ENTRY

PLEASE TICK APPROPRIATE BOX/ES BELOW

WHAT INFLUENCED YOU TO ENROL YOUR CHILD AT YARRA VALLEY GRAMMAR?

STRONG INFLUENCE

ACADEMIC EXCELLENCE

CATERING FOR INDIVIDUAL LEARNING NEEDS

CHARACTER DEVELOPMENT

FAMILY CONNECTION WITH SCHOOL

OPEN ENTRY POLICY

SCHOOLS REPUTATION
STAFF QUALITY
SUBJECT DIVERSITY/CHOICE

MODERATE INFLUENCE

OTHER PLEASE SPECIFY

PLEASE RANK FROM 15 THE MOST USEFUL SOURCES BELOW THAT ASSISTED YOU IN LEARNING ABOUT YARRA VALLEY GRAMMAR,
(WITH 1 THE MOST USEFUL)

ADVERTISEMENT (PLEASE TICK THE RELEVANT BOX)

WHICH SCHOOL? MAGAZINE

LEADER

THE WEEKLY

INDEPENDENT SCHOOLS GUIDE

MELBOURNES CHILD

OTHER

OUTDOOR BILLBOARDS/SIGNAGE
NEW MEDIA/DIGITAL MEDIA (IE. BLOGS, WEBSITES, WIKIS OR SOCIAL MEDIA), PLEASE SPECIFY:

DIRECTORIES/LISTINGS (IE. GOOD SCHOOLS GUIDE, YELLOW PAGES, WHITE PAGES), PLEASE SPECIFY:

OPEN MORNING
FAMILY MEMBER ATTENDS OR HAS ATTENDED THE SCHOOL
FRIEND OR COLLEAGUE REFERRAL / WORD OF MOUTH
YVG WEBSITE
PROSPECTUS (PRINTED)
PROSPECTUS (ONLINE)
SCHOOL TOUR
OTHER, PLEASE SPECIFY:

WHAT HAS PROMPTED YOU TO APPLY AT THIS TIME?

NO INFLUENCE