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IN SCHOOL STUDENT RECORDS
Student 3:

Please check and confirm that our records are accurate and up to date

TO BE COMPLETED BY FULL-TIME, PART-TIME AND ONLINE STUDENTS WHO ATTEND IN PERSON SESSIONS AT THE SCHOOL (INCLUDING AFTER SCHOOL OR WEEKENDS)

If your sessions are online only click to be redirected to the ONLINE FORM

Your Details

First Name

Last Name

Email

Mobile

Student 3

PERSONAL INFORMATION: It is important that we have accurate details for each student. If any personal details have changed please update this form and let us know as soon as possible.

MEDICAL RECORDS AND MEDICINE AT SCHOOL: Please disclose all medical information that may impact on the student's learning or behavior in school.
If you would like us to adminster any medication please make sure this is labelled with details of dosage. You will also need to state your consent on this form and tick the box below.

DIETARY AND ALLERGIES
Please disclose full details of all dietary requirements, allergies or conditions.

ED PSYCH REPORTS
If you have an Ed Psych Report please email this to Pip Block at office@a1student.com

First Name

Last Name

Date of Birth

Previous School

Do you have any dietary requirements or allergies?

Describe the Student's learning challenges?

Medical records & Medicines

Consent to Administer Medicine [if applicable]

Emergency Contact Details
We need at least two contacts, one can be the same as the primary contact above
[The third contact is optional and for caregivers / relatives]

First Emergency Contact

First Name

Last Name

Email

Mobile

Second Emergency Contact

First Name

Last Name

Email

Mobile

Third Emergency Contact

First Name

Last Name

Email

Mobile

Submit