Gladstone State High School eNewsletter

Student Change of Details

IS THIS A CHANGE IN FAMILY SITUATION? *

Note: If yes, please provide as much information as possible with any instruction the school needs to be aware of. *

Student Name *

Care Class

DATE FAMILY MOVED TO ADDRESS:

Street

City

Postcode

PARENT GUARDIAN 1 DETAILS

Name

Relationship to student

Phone (H)

Phone (W)

Mobile

Occupation

Work Place

Bank Details BSB

Bank Details Account Number

Bank Details Account Name

PARENT GUARDIAN 2 DETAILS

Name

Relationship to Student

Phone (H)

Phone (W)

Mobile

Occupation

Work Place

Bank Details BSB

Bank Details Account Number

Bank Details Account Name

FAMILY NOTES eg: change in family situation

FAMILY NOTES *

CUSTODY DETAILS

EMERGENCY CONTACTS OTHER THAN GUARDIANS

Contact Name

Relationship to student

Phone (H)

Phone (W)

Mobile

Signature of Guardian *

Undo

Clear

Write your signature above the line

Name of Guardian *

If the change is the student living with someone other than parents the parents need to sign this form. If not the school will contact the parents to verify.