Change of Details Form - Berry Public School

Dear Parents / Carers

We would appreciate if ALL families complete the Family Contact Details form.

A new field has been added for your child’s Medicare Card details.

It is imperative we have accurate information for situations where your child may be involved in an accident while at school or on an excursion. If an ambulance is called we are required to provide them with this information.

We have listened to feedback about having your medicare details entered on every form, this information will save parents/carers when completing permissions forms.

Parents of students in Year 6 going into High School, the address field entered on the Year 7 EOI must match the address we have on file.

It is always important the school has the most up to date information & should your details change throughout the year please update them via this form as required .

Thank you for your assistance and prompt response.

Jo & Admin team

Update Family Contact Details

Student's Name *

Medicare Card Information

Medicare Number

Valid to month:

Valid to year:

Parent/Carer's full name *

Parent contact Email Address *

First parent/carer contact name *

First parent/carer phone number *

Second parent/carer contact name

Second parent/carer phone number

Family Residential Address *

Family Residential Address

City

State/Province

Zip/Postal

Family Mailing Address as above or complete the fields below *

As Above

Family Mailing Address

City

State/Province

Zip/Postal

Other EMERGENCY contact full name *

Other EMERGENCY contact relationship to student (e.g. grandmother, grandfather, step parent, aunt etc) *

Other EMERGENCY contact phone number *

Other EMERGENCY contact full name

Other EMERGENCY contact relationship to student (e.g. grandmother, grandfather, step parent, aunt etc)

Other EMERGENCY contact phone number

Further Comments or Notes

Signature

Clear

Date