St Carthage’s Primary School

Lismore

2 Dawson Street

PO Box 1114

LISMORE NSW 2480

Phone: 02 6621 5529

stcarth@lism.catholic.edu.au

www.stcarthlism.catholic.edu.au

ENROLMENT APPLICATION STUDENT NAME: ____________________________________

Date of Birth __________________________________________

Grade: _________________________________________________

Please note:

Acceptance of this enrolment form:

• Does not imply acceptance of enrolment at St Carthage’s School

• Does not constitute acceptance into any other Catholic School

• Is subject to the approval of the Enrolment Committee

A copy of the following documents must be attached for this application to be processed, the

student’s:

Birth Certificate - Baptism Certificate - Immunisation Certificate

Medicare Number - Most recent school report

OFFICE USE ONLY (copies of documents must be attached to this application)

Date Received Family Code Student Code

Birth Certificate Yes ☐ No ☐ Baptism Certificate Yes ☐ No ☐ N/A ☐

Family Medicare Card Yes ☐ No ☐ Immunisation

Certificate Yes ☐ No ☐

School Report Yes ☐ No ☐ Court orders Yes ☐ No ☐ N/A ☐

Signed: Date:

In addition, for students who are not Australian citizens:

Passport or travel documentation No. Country of issue Expiry Date

Visa No. Visa subclass Residency status

2

Parental Occupation Definition

Government Requirement

Parental Occupation is defined as the main work undertaken by the parent/guardian. If a parent/guardian has more than 1 job, report their main job.

Group 8

Home duties If the person has not been in paid work in the last 12 months. If the person is not currently in paid work but has had a job in the last 12 months or has retired in the last 12 months, please use the person’s last occupation.

Group 1

Senior management in large business organisation, government administration and defence, and qualified professionals Senior executive/manager/department head in industry, commerce, media or other large organisation. Public Service Manager (Section head or above), regional director, health/education/police/fire services administrator. Other Administrator school principal, faculty head/dean, library/museum/gallery director, research facility director. Defence Forces Commissioned Officer. Professionals generally have degree or higher qualifications and experience in applying this knowledge to design, develop or operate complex systems; identify, treat and advise on problems; and teach others. Health, Education, Law, Social Welfare, Engineering, Science, Computing professional. Business management consultant, business analyst, accountant, auditor, policy analyst, actuary, valuer. Air/Sea transport aircraft/ship’s captain/officer/pilot, flight officer, flying instructor, air traffic controller.

Group 2

Other business managers, arts/media/sportspersons and associate professionals Owner/manager of farm, construction, import/export, wholesale, manufacturing, transport, real estate business. Specialist manager finance/engineering/production/personnel/industrial relations/sales/marketing. Financial services manager bank branch manager, finance/investment/insurance broker, credit/loans officer. Retail Sales/services manager shop, petrol station, restaurant, club, hotel/motel, cinema, theatre, agency. Arts/media/sports musician, actor, dancer, painter, potter, sculptor, journalist, author, media presenter, photographer, designer, illustrator, proof reader, sportsman/woman, coach, trainer, sports official. Associate professionals generally have diploma/technical qualifications and support managers and professionals. Health, Education, Law, Social Welfare, Engineering, Science, Computing technician/associate professional. Business/administration recruitment/employment/industrial relations/training officer, marketing/advertising specialist, market research analyst, technical sales representative, retail buyer, office/project manager. Defence Forces senior Non-Commissioned Officer.

Group 3

Tradesmen/women, clerks and skilled office, sales and service staff Tradesmen/women generally have completed a 4year Trade Certificate, usually by apprenticeship. All tradesmen/women are included in this group. Clerks bookkeeper, bank/PO clerk, statistical/actuarial clerk, accounting/claims/audit clerk, payroll clerk, recording/registry/filing clerk, betting clerk, stores/inventory clerk, purchasing/order clerk, freight/transport/shipping clerk, bond clerk, customs agent, customer services clerk, and admissions clerk. Skilled office, sales and service staff: Office secretary, personal assistant, desktop publishing operator, switchboard operator. Sales company sales representative, auctioneer, insurance agent/assessor/loss adjuster, market researcher. Service aged/disabled/refuge/child care worker, nanny, meter reader, parking inspector, postal worker, courier, travel Agent, tour guide, flight attendant, fitness instructor, casino dealer/supervisor.

Group 4

Machine operators, hospitality staff, assistants, labourers and related workers Drivers, mobile plant, production/processing machinery and other machinery operators. Hospitality staff hotel service supervisor, receptionist, waiter, bar attendant, kitchen hand, porter, housekeeper. Office Assistants, sales assistants and other assistants: Office typist, word processing/data entry/business machine operator, receptionist, office assistant Sales, sales assistant, motor vehicle/caravan/parts salesperson, checkout operator, cashier, bus/train conductor, ticket seller, service station attendant, car rental desk staff, street vendor, telemarketer, shelf stacker. Assistant/aide trades’ assistant, school/teacher’s aide, dental assistant, veterinary nurse, nursing assistant, museum/gallery attendant, usher, home helper, salon assistant, animal attendant. Labourers and related workers. Defence Forces ranks below senior NCO not included above. Agriculture, horticulture, forestry, fishing, mining worker farm overseer, shearer, wool/hide classer, farm hand, horse trainer, nurseryman, greenkeeper, gardener, tree surgeon, forestry/logging worker, miner, seafarer/fishing hand. Other worker labourer, factory hand, storeman, guard, cleaner, caretaker, laundry worker, trolley collector, car park attendant, crossing supervisor.

FAMILY INFORMATION

Family surname:

Mail to: (eg Mr & Mrs Smith)

Residential address:

Suburb: Postcode:

Postal address: (if different to residential)

Suburb: Postcode:

Phone: (please only provide phone number here if it is a residential fixed phone)

RESIDENTIAL STRUCTURE DETAILS

Married ☐ Divorced ☐ Single parent ☐ Widow ☐

Defacto ☐ Partner ☐ Separated ☐ Widower ☐

Number of Children: Male: Female:

Parish:

Health Fund:

Ambulance cover: Yes: ☐ No: ☐ Name of Provider:

Main Language spoken at home: (Funding may be available to assist students where language other than English is spoken at home)

STUDENT DETAILS (as listed on Birth Certificate - copy to be provided with application)

First name: Preferred first name:

Surname:

Date of Birth: Gender:

Commencement Year: (eg 2019) Entry Year/Grade: (eg Yr 2)

PREVIOUS SCHOOL

Name of previous school: Year Level (eg Year 1):

Address:

I/We give permission for the School to contact previous school: Yes: ☐ No: ☐

Kindergarten Enrolments only – Name of Pre-School attended ______________________________________

4

RELIGION

Catholic ☐

Other Religion ☐-state Religion: __________________

No Religion ☐

Current Parish:

Parish of St Carthage’s Lismore ☐

Other ___________________________________

BAPTISM (Please provide proof of baptism, copy to be provided with this application)

Baptised: Yes: ☐ No: ☐ Date: ____ /___ / _____ Parish:

Student Nationality

Government Requirement

Country of Birth, Australia Other, please specify

………………………………………..

(Note being born in Australia does not mean a student is an Australian citizen. If Birth Certificate

indicates that neither parent was born in Australia further evidence must be provided to determine

residency/citizenship)

Nationality

Is the student of Aboriginal or Torres Strait Islander origin? Yes No

Aboriginal by NOT Torres Strait Islander origin

Torres Strait Islander but NOT Aboriginal

Both Aboriginal and Torres Strait Islander

Does the student speak a language other than English at home? Yes No

If so please, specify (if more than one other language, indicate the one that is spoken

most often)

…………………………………………………………

Student Residential Status (original documents to be sighted and copies to be retained

by school)

Australian Citizen (Naturalisation Certificate or Passport if country of birth is not Australia)

Permanent Resident (Passport if country of birth is not Australia)

Temporary Resident (Passport and visa)

Foreign National with residential status (Passport and visa)

Other/Visitor/Student/Passport/Other/Visa (Passport and visa)

Does the student live independent of Parents/Guardians?

If yes, please provide details

…………………………………………………………………………………………………

Yes No

Student Visa (original documents to be sighted and copies to be retained by school)

Does the student have a Visa? Yes No If yes, what date of arrival in Australia

First Australian school year Former Name (If applicable)

(School must verify eligibility for enrolment of all VISA students with CSO – Human Services Officer prior to an offer of enrolment

being made)

Passport Number

Passport Nationality

Passport Expiry Date

Visa Type/Subclass

Visa Expiry Date

(original documents to be sighted and copies to be

retained by school)

ENGLISH AS A SECOND LANGUAGE (E.S.L) – if applicable

Country of Birth: Number of years lived in Australia?

Did the student speak English before starting school? Yes: ☐ No: ☐ Some ☐

Can the student speak a language other than English? Yes: ☐ No: ☐ Some ☐

Has the student ever attended E.S.L classes? Yes: ☐

If yes, when? ……………………………………………………………..

What language is mainly spoken at home

STUDENT MEDICAL INFORMATION

(copy of Medicare Card to be provided with this application)

Doctor’s Name: Phone:

Medicare Number Student Ref Number Valid to ___ / ____

Medical Conditions:

(Please specify any medical conditions eg: chronic illness, physical restriction or disability and supply supporting documentation)

Asthma: Yes: ☐ No: ☐

An action plan, signed by your doctor, must be provided before commencement at school.

Ventolin: Do you give permission for the School to administer if required: Yes: ☐ No: ☐

Anaphylaxis: Yes: ☐ No: ☐

An action plan, signed by your doctor, must be provided before commencement at school.

If YES, does the student have an EpiPen® Yes: ☐ No: ☐

If YES, does the student carry an EpiPen® Yes: ☐ No: ☐

Allergies: Yes: ☐ No: ☐

If YES, please specify any known allergies and medication required:

Diabetic: Yes: ☐ No: ☐

If YES, please specify type and medication required:

Medication: Yes: ☐ No: ☐

If YES, please specify medication taken:

Please note School staff will not administer any medication unless authority is given by

parents/carers by completing all School medication forms.

6

STUDENT IMMUNISATION Government Requirement

(A copy of the Immunisation Certificate to be provided with this application)

Diphtheria/Tetanus/Whooping Cough Yes: ☐ No: ☐ Hepatitis B Yes: ☐ No: ☐

Haemophilus Influenza type b (Hib) Yes: ☐ No: ☐ Polio Yes: ☐ No: ☐

Pneumococcal disease Yes: ☐ No: ☐ Chickenpox Yes: ☐ No: ☐

Measles/Mumps/Rubella Yes: ☐ No: ☐ Meningococcal C disease Yes: ☐ No: ☐

Human Papillomavirus (HPV)

Yes: ☐ No: ☐

(12-18yrs)

Tetanus – date of last vaccination ___ / ____ / ____

Conscientious Objector Yes: ☐ Student is unimmunised Yes: ☐

HEALTH AND SAFETY

To your knowledge, is there anything in the student’s history or circumstances (including medical history)

which might pose a risk of any type to the student, other students, or staff at the School? Yes: ☐ No: ☐

If yes, please provide a brief description:

_________________________________________________________________________________________

Please provide names and contact details of health professionals or relevant agencies that have knowledge of these issues

1) ______________________________________________________________________________________

2) ______________________________________________________________________________________

Does your child have any history of violent behaviour? Yes: ☐ No: ☐

Does your child have any history of behavioural problems (including verbal bullying)? Yes: ☐ No: ☐

Has your child ever been suspended or expelled from any previous school? Yes: ☐ No: ☐

If yes, was this for:

Actual violence to any person? Yes: ☐ No: ☐ Possession of a weapon or any item used to cause an injury?

Yes: ☐ No: ☐

Threats of violence? Yes: ☐ No: ☐ Intimidation, bullying or harassment of students or staff at a

school? Yes: ☐ No: ☐

Illegal drugs? Yes: ☐ No: ☐ Other: Please specify

I/We will provide written consent to the school on request to contact

health professionals or other relevant agencies. Yes: ☐ No: ☐

I have signed the “Agreement and Permission for Release of Information” section

of this application

Yes: ☐ No: ☐

ADDITIONAL NEEDS

Indicate whether the student applying for enrolment has any known or emerging Additional Needs.

Physical: Yes: ☐ No: ☐ Medical: Yes: ☐ No: ☐

Behavioural: Yes: ☐ No: ☐ Mental Health: Yes: ☐ No: ☐

Educational: Yes: ☐ No: ☐ Other special: Yes: ☐ No: ☐

If you have answered YES to any of the above, please provide full details of those needs and any

intervention/support that the student may be currently receiving (supporting documentation must be provided)

Please Note: If this application is successful it is an essential part of the enrolment contract that the school be advised

promptly of any changes to the needs of the student over the course of his/her enrolment. St Carthage’s School will

also regularly re-evaluate the student’s need in order to make all reasonable adjustments to best provide for his/her

overall needs within the capacity of the School.

This application gives the opportunity to provide information that will facilitate the smooth transition of your child into

our school. It will assist the school to develop appropriate strategies to meet the particular needs of your child. If the

information provided is incomplete or misleading, any decision made as to enrolment may be revised.

MOTHER/GUARDIAN DETAILS Government Requirement

First name: Title:

Surname: Relationship to Student:

Residential address

Number and street name:

Suburb: Postcode:

Does the Student reside at this address: Yes: ☐ No: ☐

Email:

Phone:(home) (work) (mobile)

Would you like to receive SMS alerts:(eg. absentee, last minute changes to excursions,

emergencies, etc)? Yes: ☐ No: ☐

Occupation: Employer:

Parental Occupation Definition (Government requirement) MOTHER

(refer to ‘Parental occupation definition’ on page 2)

Please tick the occupational group: Group 1 ☐ Group 2 ☐ Group 3 ☐ Group 4 ☐ Group 8 ☐

School education Highest qualification Country of Birth

Year 12 or equivalent ☐ Bachelor degree or above ☐ Australia ☐ Other ☐ please specify

Year 11 or equivalent ☐ Advanced diploma/Diploma ☐ Nationality:

Year 10 or equivalent ☐ Certificate I to IV ☐ Religion:

Year 9 equivalent or below ☐ No non-school qualification ☐ Main language spoken at home:

8

FATHER/GUARDIAN DETAILS Government Requirements

First name: Title:

Surname: Relationship to Student:

Residential address

Number and Street name:

Suburb: Postcode:

Does the Student reside at this address: Yes: ☐ No: ☐

Email:

Phone:(home) (work) (mobile)

Would you like to receive SMS alerts:(eg. absentee, last minute changes to excursions,

emergencies, etc)? Yes: ☐ No: ☐

Occupation: Employer:

Parental Occupation Definition (Government requirement) FATHER

(refer to ‘Parental occupation definition’ on page 2)

Please tick the occupational group: Group 1 ☐ Group 2 ☐ Group 3 ☐ Group 4 ☐ Group 8 ☐

School education Highest qualification Country of Birth

Year 12 or equivalent ☐ Bachelor degree or above ☐ Australia ☐ Other ☐ please specify

Year 11 or equivalent ☐ Advanced diploma/Diploma ☐ Nationality:

Year 10 or equivalent ☐ Certificate I to IV ☐ Religion:

Year 9 equivalent or below ☐ No non-school qualification ☐ Main language spoken at home:

NON RESIDENTIAL PARENT/GUARDIAN DETAILS (if applicable)(Where the student lives between two homes – shared access)

Title: Title:

Name: Name:

Relationship to student: Relationship to student:

Residential Address: Residential Address:

Suburb: Suburb:

Phone: (home) Phone: (home)

(work) (work)

(mobile) (mobile)

Email: Email:

FEE BILLING

Fees will be billed to the nominated parent/guardian. If you wish to change the way your account is billed (eg

father 50% and mother 50% please indicate below.

Fees billed to: …..%

Fees billed to: …..%

If address for fees billed is different to family postal address:

EMERGENCY CONTACT INFORMATION – LOCAL AREA CONTACT ONLY To be used in the event of an emergency if parents cannot be contacted, eg. grandparent or friend

FIRST EMERGENCY CONTACT SECOND EMERGENCY CONTACT

Title: Title:

Male ☐ Female ☐ Male ☐ Female ☐

Name: Name:

Relationship to student: Relationship to student:

Address: Address:

Suburb: Suburb:

Phone: (home) Phone: (home)

(work) (work)

(mobile) (mobile)

SIBLINGS ATTENDING A SCHOOL/PRE-SCHOOL

List all children in your family attending school or pre-school (from oldest to youngest), including applicant.

Name Date of birth School/Pre-school Year Level

____ / ____ / ____

____ / ____ / ____

____ / ____ / ____

____ / ____ / ____

____ / ____ / ____

____ / ____ / ____

10

COURT ORDERS (if applicable)

Are there any current court orders relating to the student? Yes: ☐ No: ☐

Are there any current Apprehended Violence Orders Yes: ☐ No: ☐

If yes, please provide copies of these court orders eg AVOs, Family Court/Federal Magistrate Court Orders or

other relevant court orders must accompany this application.

Is there other information you wish the School to be aware of? Yes: ☐ No: ☐

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

SPECIAL CIRCUMSTANCES

(if applicable)

Are there any special circumstances about the student seeking to be enrolled that the School should know prior

to enrolment? (eg: living apart from parental supervision, out of home care arranged by the state, etc)

Yes: ☐ No: ☐

________________________________________________________________________________

________________________________________________________________________________

STUDENT/PARENT AGREEMENT FORM

STATEMENT OF EXPECTATIONS FOR STUDENTS AND PARENTS Our St Carthage’s School is committed to achieving high standards. Students are challenged to achieve their potential

in all their endeavours. They are encouraged to work co-operatively in an environment where the need for equity,

mutual respect, tolerance and justice is recognised. Following are expectations for students and parents at St

Carthage’s Primary School Lismore.

• Students and parents are expected to accept the aims and goals of St Carthage’s Primary School as a

Catholic School.

• Students are expected to maintain Christian ideals and to co-operate fully in all that promotes their

complete education.

• Students are required to attend School excursions organised for their classes, and to represent the

School in any activity for which they are selected.

• Students are to care for the buildings, grounds, furniture and equipment of the School and are financially

responsible for any damage caused.

• Students may not leave the School property during school hours without permission from a

parent/guardian.

• Students are to wear the School uniform properly in order to develop a pride in personal appearance as

well as developing a sense of belonging and responsibility. This includes travel to and from school.

• Students are not permitted extremes in hairstyle, cut or colour. A student’s hair is to be neat, clean and

properly groomed. Long hair is to be tied back at all times.

• Students are to abide by School regulations in regard to the wearing of jewellery and makeup.

• Parents take on a commitment to help educate their son/daughter. Part of this commitment is fulfilled by the agreement to meet part of the cost of education by paying the full school fees, elective fees and

any levies, by the due date. • Parents are expected to take an active part, where possible, in the activities of the School.

• Students and parents are expected to accept the policies and procedures of the School as outlined in

the School Handbook.

• At all School events, functions and activities, students must respect the School by behaving according to social standards and expectations. Respect and pride of self and of the School must be maintained

in all dealings with members of the school community and the public. • Parents give consent for their children to access the school’s counselling service conditional on the

parents right to withdraw their consent at a later date if they so decide.

We have read the above expectations of St Carthage’s Primary School Lismore and by signing this form make a commitment to upholding the standards set out in these expectations. Continued infringement of these expectations could lead to the enrolment being reviewed.

Mother/Guardian name: Father/Guardian name:

Mother/Guardian signature: Father/Guardian signature:

Date: Date

12

AGREEMENT BETWEEN TRUSTEES OF THE ROMAN CATHOLIC CHURCH FOR THE DIOCESE OF

LISMORE ON BEHALF OF ST CARTHAGE’S PRIMARY SCHOOL LISMORE AND Please insert parent/guardian name here: …………………………………………………………………………………………….

(PARENT/GUARDIAN)

In dealing with this application, it may be necessary for the School, or any part of the Catholic Schools Office, to look at documents held by previous schools, health care professionals or other government agencies. This information will be collected, used and stored consistent with the Privacy and Personal Information Protection Act and Health Records and Privacy Act 2002. The consent of the owner of the information, while not always necessary, is appreciated and

will speed up the assessment of the application. Consent to Access Documents

I/We consent to St Carthage’s School, Lismore and the Catholic Schools Office gaining access to relevant information

about the student to be enrolled held by previous schools, health care professionals or other government agencies. 1. I/We have included copies of the following documents with this application for enrolment (please tick):

☐ Full Birth Certificate* ☐ Passport, visa, citizenship documentation

(if applicable) *

☐ Baptism Certificate*and any other Sacramental Certificates to date (if applicable)

☐ Relevant medical and/or special needs information

(if applicable)

☐ Most recent school report and external test results

☐ Reports of assessments your child has received for

☐ Current Family Court Orders (if applicable) * speech, hearing, cognitive (IQ), occupational therapy

☐ Immunisation Certificate (if applicable)

2. I/We understand the School may approach these bodies directly. The information they request may include

information related to any of the questions I have answered above.

Declaration

3. I/We understand and support the Catholic ethos of St Carthage’s School and agree to abide by the rules and regulations of the School including those pertaining to program of studies, sport, pastoral care, school uniform, discipline and the general operation of the School.

4. I/We undertake not to engage in social media or allow our children to engage in social media that disparages

or brings the School, employees or Trustees of the Catholic Church into disrepute. Furthermore, I / we

acknowledge the right of the School to suspend or terminate my/our child(ren)’s enrolment from the School in

the event that social media statements are made that defames or disparages the School, employees or the

Roman Catholic Church.

5. If this enrolment application is successful, I/we agree to honour the financial commitments required by the

school as per the Schedule of Fees and Charges.

6. I/We understand that if this application is successful the information that I/we have provided must be kept up

to date throughout the period of enrolment, eg change of address, court orders.

7. I/We understand the enrolment process includes an interview, an offer of enrolment and completion of an Acceptance of Enrolment form. I/We understand that acceptance by the School of this application does not imply acceptance of enrolment.

8. If this enrolment is accepted I/we agree to support our child’s participation in the religious life of the School (eg

School Masses, Liturgies, retreat programs).

9. I/We acknowledge receiving a copy of the Schedule of Standard School Fees and accept the terms and

conditions of enrolment.

10. I/We agree if my child should require urgent medical treatment, the School staff are authorised to seek medical attention. This may include transportation to the nearest hospital, medical centre or doctor by ambulance or private vehicle and I/we agree to meet all costs.

11. I/We agree to the School’s pedagogical methodology, including the use of technology in the delivery of

curriculum and other educational outcomes.

I/We have read all of the information in the enrolment package and understand the policies that we will need to abide

by should this enrolment application be successful.

I/We have read the Standard Collection Notice, about the collection and management of the personal information

contained in this form.

I/We declare that the information provided in this Enrolment Application is, to the best of my knowledge and belief,

accurate and complete.

I/We recognise that, should statements in this application later prove to be false or misleading, any decision made as

a result of this application may be reversed, amended or revoked.

Mother/Guardian Father/Guardian

First Name: First Name:

Surname: Surname:

Residential Address: Residential Address:

Date of Birth: Date of Birth:

Occupation: Occupation:

Mother/Guardian signature: Father/Guardian signature:

Date: Date:

Page 14

In accordance with the Enrolment Guidelines and Support Procedures (Catholic Schools Office – Diocese of Lismore)

and the Lismore Catholic Education Privacy Policy, permission must be given by the parent/s or guardian/s of a student

to allow the Principal or school representative to contact, collect and record any relevant information (either orally or via

documentary material or reports) about the child. To comply with the Privacy Act 2000 and current NSW Law I understand

my child’s records will be stored in a confidential file, for a period of seven years after my child has left school.

I/We

(Parent/Guardian name) _________________________________________________________________

hereby authorise the release of any relevant information concerning my child to appropriate Professionals (medical,

therapy or education).

I give permission to teachers and others who may be concerned with my child’s education, development or welfare to attend case conferences or meetings with Catholic Schools Office personnel and to share information

about my child.

If you wish to limit the above permission in any way, please explain below:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Mother/Guardian name: Father/Guardian name:

Mother/Guardian signature: Father/Guardian signature:

Date: Date:

Please note:

Acceptance of this application for enrolment is subject to the approval of the school’s Enrolment Committee.

Acceptance to this school does not constitute acceptance into any other Catholic School (primary or secondary).

AGREEMENT AND PERMISSION FOR RELEASE OF INFORMATION

Page 15

Dear Parent/Guardian

At certain times throughout the year, our students may have the opportunity to be photographed or filmed for our school

publications, such as the school’s newsletter, website or social media, to promote the school in newspapers and other

media.

The Catholic Education Commission of New South Wales (CECNSW) and the Catholic School Office Lismore (CSO)

may also wish to use student photographs/videos in print and online promotional, marketing, media and educational

materials.

We would like your permission to use your child’s photograph/video for the above purposes. Please complete the

permission form below.

Thank you for your continued support.

Student’s name: ________________________________ Year level: ________________________________

• I give permission for my child’s photograph/video and name to be published in/on:

- The school newsletter

- The school intranet

- The school website

- Social media

- Promotional materials

- Newspapers and other media

I authorise the CECNSW/CSO to use the photograph/video in material available free of charge to schools and

education departments around Australia for the CECNSW/CSO’s promotional, marketing, media and educational

purposes.

• I give permission for a photograph/video of my child to be used by the CECNSW/CSO in the agreed publications

without acknowledgement, remuneration or compensation.

I understand and agree that if I do not wish to consent to my child’s photograph/video appearing in any or all of the

publications above, or if I wish to withdraw this authorisation and consent, it is my responsibility to notify the school.

Licensed under NEALS: The photograph/video may appear in material which will be available to schools and education

departments around Australia under the National Educational Access Licence for Schools (NEALS), which is a licence

between education departments of the various states and territories, allowing schools to use licensed material wholly and

freely for educational purposes.

Mother/Guardian name: Father/Guardian/Carer name:

Mother/Guardian signature: Father/Guardian/Carer signature:

Date: Date:

If a student is aged 15+, student must also sign:

Student name: Student signature:

Date:

Any personal information will be stored, used and disclosed in accordance with the requirements of the Privacy Act 1988 (Cth) and the Privacy Amendment (Enhancing Privacy Protection) Act 2012.

Office Use Date of Photograph/Video: (month& year)

PHOTOGRAPH / VIDEO PERMISSION FORM

Page 16

STANDARD COLLECTION NOTICE

1. The school (the Diocese both independently and through its schools) collects personal information, including sensitive

information about pupils and parents or guardians before and during the course of a pupil’s enrolment at the school.

This may be in writing or in the course of conversations. The primary purpose of collecting this information is to enable

the school to provide schooling to the pupil and to enable them to take part in all the activities of the school.

2. Some of the information we collect is to satisfy the school’s legal obligations, particularly to enable the school to

discharge its duty of care.

3. Laws governing or relating to the operation of a school require certain information to be collected and disclosed.

These include relevant Education Acts and Public Health and Child Protection Laws.

4. Health information about pupils is sensitive information within the terms of the Australian Privacy Principles under the

Privacy Act. We may ask you to provide medical reports about pupils from time to time.

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. 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, the Catholic Schools Office, the Catholic

Education Commission of New South Wales, your local diocese and the parish, schools within other dioceses/other

dioceses, medical practitioners, and people providing services to the school, including specialist visiting teachers,

(sports) coaches, volunteers and counsellors.

7. The school from time to time may also collect and disclose personal and sensitive information about current or

prospective students to others if it is required to satisfy the school’s legal obligations under Part 5A of the Education

Act 1990 (NSW).

8. The school may disclose and/or receive relevant personal information to/from debt collection agents and credit

reporting agencies.

9. Personal information collected from pupils is regularly disclosed to their parents or guardians. On occasions personal

information disclosed to a school counsellor may be disclosed to others who have a legal obligation to receive it

without betraying a confidence. However, there will be some occasions where it is necessary to directly pass on

material which relates to the wellbeing of a pupil of the school.

10. Schools may also disclose information under public health and child protection laws or in circumstances where there

is a serious threat to an individual’s life, health or safety.

11. The school may store personal information in the ‘cloud’ which may mean that it resides on servers which are situated

outside Australia.

12. Parents may seek access to personal information collected about them and their son/daughter by contacting the

school principal. Pupils may also seek access to personal information about them. However, there will be occasions

when access is denied. Such occasions would include where access would have an unreasonable impact on the

privacy of others, where access may result in a breach of the school’s duty of care to the pupil or where pupils have

provided information in confidence.

13. The Dioceses’ Privacy Policy also sets out how you may complain about a breach of privacy and how the school will

deal with such a complaint.

14. The school from time to time engages in fundraising activities. Information received from you may be used to make an appeal to you. It may also be disclosed to organisations that assist in the school’s fundraising activities solely for that purpose. We will not disclose your personal information to third parties for their own marketing purposes without your consent.

15. On occasions information such as academic and sporting achievements, pupil activities and similar news is published

in school newsletters and magazines and on the school’s intranet. Photographs of pupil activities such as sporting

events, school camps and school excursions may be taken for publication in school newsletters and magazines and

on our intranet. The school will obtain separate permissions from the pupils’ parents or guardians prior to publication

if we would like to include photographs or other identifying material in promotional material for the school or otherwise

make it available to the public such as the internet.

16. If you provide the school with the personal information of others, such as doctors or emergency contacts, we

encourage you to inform them that you are disclosing that information to the school and why, that they can access

that information if they wish and that the school does not usually disclose the information to third parties.

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VOLUNTEER DECLARATION for Child Protection

in Schools

Diocese of Lismore

First Name ..................................................................... Surname ...............................................................................

Residential Address........................................................................................................................................................

Contact details - Phone.................................................... Email: ..................................................................................

As Volunteer/worker for St Carthage’s Primary School at Lismore

I hereby declare that:

1. I am in child-related work, or applying to be in child-related work, within the meaning of the NSW Child Protection (Working with Children) Act 2012, but am exempt from the requirement to hold a working with children check clearance under the Child Protection (Working with Children) Regulation 2013 at the time of the making of this declaration. 2. I have not been refused a working with children check clearance under the Child Protection (Working with Children) Act 2012 (this declaration may be made if a clearance was subsequently granted to you). 3. I have not had a working with children check clearance cancelled under the Child Protection (Working with Children) Act 2012 (this declaration may be made if the clearance was surrendered by you, a clearance was subsequently granted to you, or the cancellation was overturned on review). 4. I am not currently subject to an interim bar on engaging in child related work under the Child Protection (Working With Children) Act 2012. 5. I have not been convicted of an offence, or subject to a finding of guilt for an offence or a finding that the charge for an offence is proven, where the offence was committed as an adult in NSW or elsewhere and was an offence of the following kind:

a) a sexual assault or intercourse offence; b) the common law offence of rape or attempted rape; c) an indecent assault offence; d) a sexual servitude offence; e) observing a person engaged in a private act, for the purpose of obtaining sexual arousal or sexual gratification (voyeurism); f) filming another person engaged in a private act or filming another person’s private parts, for the purpose of obtaining, or enabling another person to obtain, sexual arousal or sexual gratification;

g) installing a device, or constructing or adapting the fabric of a building, for the purpose of facilitating the observation or filming of a child, with the intention of enabling any person to commit an offence referred to at (d)-(e) above;

And I make this declaration believing this to be true.

Signature…………………………………………………………………………………………

murder of a child;

h) manslaughter of a child (other than as a result of a motor vehicle accident); i) intentional wounding or causing grievous bodily harm to a child who was three or more years younger than me; j) a child prostitution offence; k) an offence involving an act of indecency with or towards a child; l) procuring or grooming a child under 16 years of age for unlawful sexual activity; m) using a child for the production of child abuse material, or producing, disseminating, possessing or importing child abuse material; n) possessing or importing child pornography; o) offences relating to the use of a postal or similar service or child pornography material or child abuse material; p) offences relating to the use of a postal or similar service involving sexual activity with a child under 16; q) publishing indecent articles; r) an offence of kidnapping a child, unless a parent or carer of the child at the time of the offence; s) a forced labour or deceptive recruiting for labour or services offence, where the victim was a child; t) intentional or reckless infliction of grievous bodily harm on a child, during or after the delivery of the child; u) intentionally abandoning or exposing a child under the age of seven; v) bestiality; w) an offence an element of which is an intention to commit one of the above offences; or x) an offence of attempting, or of conspiracy or incitement, to commit one of the above offences.

Date…………./………../…………

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Undertaking – as a condition of continuing to perform child-related

work

I undertake, as a condition of my continuing to perform child-related work (including volunteering) for

St Carthage’s Primary School at Lismore that I will notify the School/CSO Lismore of:

(a) any refusal to grant me a Working With Children Check clearance under the NSW Child Protection

(Working with Children) Act 2012;

(b) the cancellation of any Working with Children Check clearance I may hold under the NSW Child

Protection (Working with Children) Act 2012;

(c) the imposition of an interim bar under the NSW Child Protection (Working with Children) Act 2012

that prevents me from engaging in child-related work that requires a working with children check

clearance; and

(d) any conviction for an offence, or finding that I am guilty of an offence, or finding that the charge for

an offence against me is proven, where the offence is of the kind referred to in this Declaration.

Furthermore, I am aware that providing false or misleading information in this document may lead to the

following:

• withdrawal of any offer of engagement made to me; or

• termination of my engagement; and

• any false or misleading information provided by me may be taken into account when considering any

future applications by me for employment or engagement in the Catholic Diocese of Lismore.

Signature................................................................................................... Date ............../................/.................

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ENROLMENT

This form is to be completed by parents seeking to enrol their child at St Carthage’s Primary School. However, completion of this form in no way guarantees enrolment. An interview with the Principal must occur before offers of enrolment are made.

St Carthage’s School population is drawn from the Catholic communities of the Cathedral Parish. Children applying for enrolment at St Carthage’s School are subject to the Enrolment Policy formulated by the Catholic Schools Office. This policy states that all children must be turning five years of age by 31st July in their first year of school. Eligibility

Priority is given to a. Catholic families with a commitment to the faith life, worship and service of the parish; b. Other Catholic families of the parish; c. Catholic families from other parishes.

There is also an intake of other than Catholic students provided that: a. The Principal and Parish administrator agree; b. There are vacancies; c. The pupil participates in all Religious Education programs d. Following an interview with the parents, the Principal and Parish Administrator are convinced that they are in complete agreement with the philosophies and practices of the school.

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2019 School Term Dates

Term 1

January 29th – Friday 12th April (Pupil Free Day)

Students finish on Thursday 11th April.

Term 2

Monday 29th April – Friday 5th July (Pupil Free Day)

Students finish on Thursday 4th July

Term 3

Monday 22nd July (Pupil Free Day)–

Friday 27th September

Students commence Tuesday 23rd July

Term 4

Monday 14th October (Pupil Free Day) –

Friday 20th December –

(Thursday 19th & Friday 20th December Pupil Free Days)

Students commence Tuesday 15th October

Students finish on Wednesday 18th December

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2019 Public Holidays

Good Friday 19th April

Easter Monday 22nd April

Anzac Day 25th April

Queen’s Birthday 10th June

Labour Day 7th October

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intentionally.