Student's Full Name (This name should match your child's birth certificate)
Date of Birth (Please format as DD/MM/YY)
Year of Entry
- Choose -
Entry Year Level
- Choose -
Language Spoken (at home)
Language Spoken (other)
Country of Birth
INTERNATIONAL STUDENTS Under which status/visa will the student apply?
Passport Details Passport number & expiry date
Visa Details Visa number, subclass, expiry date
Health Cover Details Overseas student health cover: Company, policy number & expiry date
Year Level at Present School
- Choose -
Birth Certificate Please attach: A copy of Birth Certificate. International Students to supply a copy of Passport and Visa details.
Recent photo of your daughter (A clear, passport sized individual photo)
Current School report Please attach a copy of current school report
Current NAPLAN Report Please attach a copy of current NAPLAN report
LEARNING ENHANCEMENT NEEDS (Support or Enrichment)
Please give details (Please attach all relevant documentation)
Please note: Please advise us of the listed Special Considerations. Please note: If the Learning Enhancement needs section is not completed, the College will assume your daughter does not have specific learning needs which require support. Non-disclosure may lead to a review of this enrolment. Documentation provided will be forwarded to the Learning Enhancement Centre.
Special Learning Needs
Resides with student
Parent 1 Residential Address
Postal Address (If different from residential)
Resides with student
Parent 2 Postal Address (If different from residential)
Family Court Orders/Custody Details If applicable, include copies of any documentation in relation to any Family Court order or binding agreement regarding residency, contact, or any other parenting issues which apply to the student. This is a requirement of admission.
Are court orders in place?
Documentation: Provision of any documentation in relation to any Family Court order or binding agreement regarding residency, contact, or any other parenting issues which apply to the student is a requirement of admission.
FAMILY DETAILS: Siblings Name(s) of siblings and school attended
Current/Past Students Are any family members current or past students of Fairholme College? (If past student, please state maiden name, house and year they le school):
Please attach documentation
Relationship to student
Year of leaving/Current Year level
Maiden Name (if applicable)
Additional family members (if there are multiple family members please list details in box below)
FAMILY REFEREE: Please state the name and address of parents’ referee to whom the Principal may refer.
Family Referee Full Name
Referee Home Phone
Referee Mobile Phone
Referee Work Phone
Referee Email Address
STUDENT MEDICAL DETAILS*: Please note any medical conditions and attach any documentation that outlines previous and/or existing physical, emotional or mental conditions that may affect your daughter’s progress. Note that the Fairholme College Medical Form will be sent for completion prior to final enrolment. Some students at Fairholme have an extreme and life threatening reaction to peanuts and, as such, we seek care and caution from all members of the College community.
EMERGENCY CONTACT: (Other than parents listed) If future mail from school does not reach you promptly or parents are not available (eg. grandparents, neighbours, close friend)
Emergency contact Full name
Emergency contact Relationship to student
Emergency Contact Home Phone
Emergency Contact Mobile Phone
Emergency Contact Work Phone
Emergency Contact Email Address
PAYMENT OPTIONS: Please indicate how you intend to make payment of the non-refundable application fee of $110 (Day Students/Boarders) and $132 (Overseas students) by checking one of the options below:
DECLARATION: I/We, the parent/s or guardian/s agree to the Conditions of Entry ›. This includes being joint and severally liable to pay the school account within the specifed time on the invoice. Also, that one term’s notice, in writing to the Principal, is required prior to the withdrawal of a student, or the change of status from Boarder to Day student. If not received, a full term’s fee in lieu of notice will be charged.