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Wellbeing Form

Wellbeing Form

Please complete and submit this form prior to your interview at the College. If you have any questions, please contact the College Registrar on 9414 4055 or enrolments@emmanuel.wa.edu.au

Supporting documentation is required to complete this form. Please have this ready to submit prior to starting the form.

Student Name(Required)

First Middle Last

Year of Entry into the College(Required)

E.g. Year 7/2025

Person Completing the Form Name(Required)

First Last

Phone(Required)

Email(Required)

Does your child have a Medical/Health Care/Disability Condition?(Required)

Yes

No

Diagnosis

File Upload(Required)

Please upload supporting documents relating to your child’s diagnosis.

Max. file size: 50 MB.

Medication

Does your child receive any services from an external agency, which may affect educational arrangements?(Required)

Yes

No

Please explain

File upload

If medical/health care services are required during school hours, please provide full details, name, contact number and signed authorisation by the relevant practitioner (upload here).

Max. file size: 50 MB.

Has your child received services from Psychological/Psychiatric Services?(Required)

Yes

No

Please explain

Has your child received services from Learning Support?(Required)

Yes

No

Please explain

Does your child have any needs in the following areas?

Please select all that apply.

Sensory (e.g. Vision/Hearing)

Behavioural/Safety

Learning Difficulties

Communication Difficulties

Please explain

Doctor's Name

First Last

Doctor's Practice

Doctor Phone

Medicare Number

Please include the reference number for your child.

Private Heath Fund

Child Allergies

Does your child wear a Medical Alert Bracelet?

Yes

No

Signatures of Caregivers

Each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed, and that any electronic signatures appearing on this Agreement or such other documents are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.

Caregiver 1 Signature(Required)

Caregiver 2 Signature

Date(Required)

DD slash MM slash YYYY

Contact

admin@emmanuel.wa.edu.au

(08) 9414 4000

Whadjuk Boodjar
122 Hammond Road
Success 6164
Western Australia

Absentees

Please report by 9.00am on the day of absence, using the College App.
The College App can be downloaded from iTunes or Google Play.

As a Catholic Education Western Australia (CEWA) school, Emmanuel Catholic College collects, stores, uses, and discloses your personal information in accordance with the CEWA Privacy Policy and Privacy Collection Notices you may find here .

Emmanuel Catholic College acknowledges and pays respect to the Traditional Owners and Elders,
both past and present of the land on which our College is located, the Whadjuk people of the Nyungar Nation.

© 2024 Emmanuel Catholic College