* Required

Please submit a separate Registration Form for each child. Parent information fields need only be completed once.

Full name of person filling out this formrequired

Email Address for Confirmation Emailrequired

Student Information

Student Given Namesrequired

Preferred Name (if applicable)

Student's Surnamerequired

Date of Birthrequired

dd/mm/yyyy

Sex*

Male Female

Current School

Nationality

Australian Citizen

Yes No

Permanent Resident

Yes No

Religious Denomination

Is the student Aboriginal or Torres Strait Islander origin?

No Yes - Aboriginal Yes - Torres Strait Islander Yes - Both Aboriginal and Torres Strait Islander

Proposed Calendar Year of Entry

Term of Entry

Academic Year of Entry

Status of Entry

Day Student Boarder (Girls from Year 4)

Applicant Lives with

If other

Parents' Marital Statusrequired

Siblings enrolled (current)

Siblings enrolled (past)

Mother - Frensham Old Girl?

Yes No

If so, Maiden Name?

Father - Past Student?

Yes No

If so, years at Gib Gate?

Other family connection

Father / Parent 1 / Guardian 1 Information

Title

Given Names

Surname

Home Address

Suburb/City

State

Postcode

Postal Address: (if different)

Telephone Home

Mobile

Occupation

Employer

Business Address

Business Telephone

Signature: (type name)

Date (mm/dd/yyyy)

Mother / Parent 2 / Guardian 2 Information

Title

Given Names

Surname

Home Address

Suburb/City

State

Postcode

Postal Address: (if different)

Telephone Home

Mobile

Occupation

Employer

Business Address

Business Telephone

Signature: (type name)

Date (mm/dd/yyyy)

General

How would you like to pay the registration fee?

Credit Card Cheque/Money Order Direct Deposit

Please send a confirmation email to the address below*: