Enrolment Form

Step 1 of 7

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Student Details

Full Name(Required)

First Last

Preferred Name

Gender(Required)

Female

Male

Other

Date of Birth(Required)

Day

Month

Year

(Please attach copy of birth certificate)

Country of Birth(Required)

Language spoken at home(Required)

Cultural background(Required)

Is the student a Permanent Resident of Australia(Required)

Yes

Visa Category(Required)

Is the student of Aboriginal or Torres Strait Islander descent?(Required)

Yes

Main home address(Required)

Number and Street address Suburb Postal Code

Other home address (if applicable)

Number and Street address Suburb Postal Code

Student lives with(Required)

Both parents

Mum

Dad

Other

Is there any court order or agreement regarding contact with, or responsibility for the child?(Required)

Yes

If yes, please attach details.

Attach court order or agreement:

Drop files here or

Max. file size: 128 MB.

Does your child have a Victorian Student Number (VSN)? (All students who have been enrolled in a Victorian school have a VSN)(Required)

Yes (please specify)

Yes, but the VSN is unknown

No, the student has never been issued a VSN

Please specify(Required)

Parent Details

Parent/Guardian 1(Required)

Prefix First Last

Preferred name

Relationship to student(Required)

Country of birth(Required)

Languages spoken(Required)

Interpreter required?(Required)

Yes

Cultural background(Required)

Occupation(Required)

Address for this parent/guardian(Required)

Number and Street address Suburb Postal Code

Home phone

Business phone

Mobile(Required)

Email(Required)

Does the student live with this parent/guardian?(Required)

Yes

Parent/Guardian 2

Prefix First Last

Preferred name

Relationship to student

Country of birth

Languages spoken

Interpreter required?

Yes

Cultural background

Occupation

Address for this parent/guardian

Number and Street address Suburb Postal Code

Home phone

Business phone

Mobile

Does the student live with this parent/guardian?

Yes

Medical and Emergency details

Doctor's Name(Required)

Practice Name(Required)

Address(Required)

Suburb Postcode

Doctor contact phone number(Required)

Current Ambulance subscription number

Current Medicare number

Student's number on Medicare card

Child Health Care Card(Required)

Yes

Expiry Date(Required)

Family Health Care Card(Required)

Yes

Expiry Date(Required)

Ambulance Cover(Required)

Yes

Ambulance Subscription number(Required)

In the event of illness or injury to your child whilst at school, on an excursion, or travelling to or from school; do you authorise the Principal/teacher-in-charge of your child, where the Principal/teacher-in-charge is unable to contact you, or it is otherwise impracticable to contact you to:

Consent to your child receiving such medical or surgical attention as may be deemed necessary by a medical practitioner?(Required)

Yes

Administer such first aid as the Principal or staff member may judge to be reasonably necessary?(Required)

Yes

Does your child require regular medication?(Required)

Yes

If yes, please complete a Medication Authority form signed by a medical practitioner and provide details(Required)

Does your child have medical/other conditions that require attention at school (e.g. diabetes, epilepsy, etc.)(Required)

Yes

If yes, please attach the relevant action plan and provide details(Required)

Please attach the relevant action plan(Required)

Drop files here or

Max. file size: 128 MB.

Has your child been diagnosed at risk of Anaphylaxis?(Required)

Yes

If yes, please attach Anaphylaxis Action Plan signed by a medical practitioner.(Required)

Drop files here or

Max. file size: 128 MB.

Has your child been diagnosed with asthma?(Required)

Yes

If yes, please attach Asthma Action Plan signed by a medical practitioner.(Required)

Drop files here or

Max. file size: 128 MB.

Does your child have any allergies or dietary sensitivities?(Required)

Yes

If yes, please provide details(Required)

Please attach Allergy Action Plan signed by a medical practitioner(Required)

Drop files here or

Max. file size: 128 MB.

Is your child’s Immunisation History Statement attached?(Required)

Yes

(Mandatory requirement)

Emergency Contacts

Please clearly list at least two people who could be contacted in an emergency if parents are unavailable.

Name(Required)

Relationship to student

Phone Number(Required)

Email(Required)

Name(Required)

Relationship to student

Phone Number(Required)

Email(Required)

Name

Relationship to student

Phone Number

How will the student travel to school?

Are they able to travel independently?(Required)

Yes

Does the student have a mobile phone?(Required)

Yes

Student's mobile number(Required)

Declaration

I/we declare that the information provided on this form is accurate and that I/we will notify Tombolo Academy of any changes in student’s medical details, residential address, email address and contact telephone numbers and including emergency contact details within seven days of a change occurring. I/we accept responsibility for full payment of the school fees as set by the Board, at the start of each year or from the point when my child is enrolled if this is part way through a year for the period my child attends Tombolo Academy. The annual fee is $13,780 (tuition fee) + $530 (Excursions) + $265 (ICT levy) = TOTAL $14,575

Parent / Guardian 1 Name(Required)

Relationship to student

Today's Date

Day

Month

Year

Signature(Required)

Parent / Guardian 2 Name

Relationship to student

Today's Date

Day

Month

Year

Signature

Applicant Agreement Acknowledgement

Please indicate your acknowledgement of each of the points listed by placing an x in each of the boxes provided.

I/We have read and understood...(Required)

The School’s Enrolment Agreement jointly and severally agreement to be bound by the terms and conditions of this Agreement, and related policies including the Parent & Guardian Code of Conduct.

I/We hereby declare that...(Required)

The information supplied is true and correct. I understand and agree that Tombolo Academy may cancel my enrolment if false or misleading information has been provided by me during the enrolment or during my course.

I/We support...(Required)

The values of Tombolo Academy and will work in partnership with Tombolo Academy in the best interests of our child and all other students.

I/We will support...(Required)

My/our child in complying with Tombolo Academy’s Student Code of Conduct and Policies found on the web page at www.tombolo.vic.edu.au for the time being in force that I/we will keep the Tombolo Academy indemnified against any loss or damage caused by any failure of my/our child to observe the aforesaid. I/we also understand that the student is always expected to act in accordance with the values and policies of the Tombolo Academy and that serious breaches in this regard could lead to cancellation of an enrolment.

I/We consent...(Required)

To use of photographs and/or audio/visual material of the Student in print and online for distribution with the Tombolo Academy community (photographs would not be captioned names). The Applicant consents to such use and disclosure of the Student’s photographs and/or audio/visual material unless such consent is expressly withdrawn via written notification to the Tombolo Academy.

I/We consent...(Required)

To Tombolo Academy using your personal information and the Student’s personal information for the purposes of receiving Tombolo Academy marketing communication such as our Tombolo Academy magazine or invitations to Open Morning or philanthropic support for Tombolo Academy, by mail or email. You may at any time opt out of any of the above marketing communication either by advising our Business Manager via email that you wish to opt out from this marketing communication.

I/We acknowledge that,...(Required)

Unless otherwise agreed in writing with Tombolo Academy. I/we, as parent/parents/guardian/guardians, are and will remain jointly and severally liable for the payment of fees. Should any fees not be paid by the due date then Tombolo Academy may, in its sole discretion suspend or terminate our child’s enrolment at Tombolo Academy and take legal action to recover outstanding fees. I/We agree to pay all fees owing and by the due date.

If I/We fail...(Required)

To comply with the requirements outlined above, Tombolo Academy reserves the right to invoice me/us for one Term’s fees in lieu of notice.

In the event of any...(Required)

Medical or other emergency arising in which Tombolo Academy considers it impossible or impracticable to communicate with the undersigned parents/guardians. Tombolo Academy will take all reasonable care of my/our child but will not be responsible for costs of any medical or dental attention or treatment administered to my/our child in such event nor will it be responsible directly or indirectly for any act or omission of any medical or dental practitioner or medical officer attending or treating my/our child including attention provided at Tombolo Academy.

I/We consent...(Required)

To Tombolo Academy arranging first aid and medical treatment in the event of an emergency and indemnifies Tombolo Academy for the cost of any such treatment.

I/We agree that...(Required)

The Student may access the services of Tombolo Academy specialists such as the Wellbeing staff. The Applicant consents to those services being provided to the Student and for confidentiality between Student and specialist to be maintained without reference to the Applicant where the specialist deems that appropriate.

I/We agree that...(Required)

Tombolo Academy is not liable for any loss or damage to property of the Applicant or the Student including musical instruments, sporting equipment, electronic devices and clothing, caused by the Student, by other Students or by third parties other than Tombolo Academy.

I/We agree that...(Required)

To indemnify the Tombolo Academy for any loss or damage to Tombolo Academy property arising from the use or possession of such property by the Student.

The Principal, or their nominee,(Required)

Has authority to apply whatever disciplinary measures are appropriate or necessary in relation to the conduct of my/our child, both inside Tombolo Academy and at outside Tombolo Academy related events. This includes behaviour whether inside or outside the Tombolo Academy that might bring the good name of Tombolo Academy into disrepute and may include the decision to suspend/exclude/expel the student for any cause judged to be sufficient.

Tombolo Academy(Required)

Does not insure my/our child’s property of any description.

The consent which I/we have given...(Required)

Is valid at all times while the student is in the custody of the Tombolo Academy, including but not limited to, such times as the student is on campus, is present at school camps or attending or participating in an excursion or function.

This agreement...(Required)

Will be binding and remain in force for the duration of my/our child’s enrolment at Tombolo Academy. This Agreement commences from the time this agreement is signed by either parent or guardian and terminates at the time the enrolled child ceases to be a Tombolo Academy student. The grounds on which it may be terminated are a student leaving the school for any reason, being that of graduation, leaving for another school, expulsion etc. This agreement is not terminated if a student is suspended and remains in force for the period of suspension.

Parent / Guardian 1(Required)

Date(Required)

Day

Month

Year

Signature(Required)

Parent / Guardian 2(Required)

Date(Required)

Day

Month

Year

Signature(Required)

Third Party Witness(Required)

Date(Required)

Day

Month

Year

Signature(Required)

Third Party Witness(Required)

Date(Required)

Day

Month

Year

Signature(Required)

This form may collect personal information about you or another person. Where you provide information about another person, you should obtain that person’s consent to you providing this information to Tombolo Academy. You and the other person have a right to access personal information that Tombolo Academy holds about you. Tombolo Academy handles all personal information in accordance with its Privacy Policy. Please complete, sign and have witnessed all sections of this form; otherwise it will be returned for completion.

The offer of enrolment will not ordinarily be processed unless accompanied by this signed Enrolment Agreement and we have received:

completed express of interest form

evidence of disability and giftedness as described in the admission eligibility information on the website

payment of a non-refundable application fee of $300

Have you attached...

Victorian Student Number:

YES

Disability assessment:

YES

Birth certificate:

YES

Immunisation History Statement:

YES

Allergy Action Plan:

YES

Asthma Action Plan:

YES

Anaphylaxis Action Plan:

YES

Medical/other conditions details:

YES

Medication Authority form:

YES

We empower neurodiverse learners.

We're passionate about challenging assumptions and shifting perspectives about our students. At Tombolo Academy, we empower highly capable neurodiverse learners to embrace their unique strengths and talents. Our goal is to foster a love for learning and build confidence in every student.

HELEN BARRET,
PRINCIPAL

About Tombolo

Enrolment Form

Student Details

Parent Details

Medical and Emergency details

Emergency Contacts

Declaration

Applicant Agreement Acknowledgement

We empower neurodiverse learners.

Tombolo Academy

admin@tombolo.vic.edu.au

(03) 9598 7552