Peregian Springs State School eNewsletter

Change of Contact Details

Much of our communication with families is electronic so it is therefore important that your contact details are up to date in order that we can keep you informed. We may also need to call you should your child be sick or injured.

Office staff will confirm these changes prior to altering your child's online records.

The Department of Education and Training, through Peregian Springs State School, is collecting personal information in accordance with Education (General Provisions) Act 2006 in order to update family and student emergency contact details. The information will only be accessed by Department of Education and Training. The information will not be given to any other person or agency unless consent is provided.

Child's Name *

Only complete fields below where details have changed

Parent/Guardian contact 1 - Name

Parent/Guardian contact 1 - Address

Parent/Guardian contact 1 - Mobile

Parent/Guardian contact 1 - Home telephone

Parent/Guardian contact 1 - Occupation and place of work

Parent/Guardian contact 1 - Work telephone

Parent/Guardian contact 1 - Email address

Parent/Guardian contact 2- Name

Parent/Guardian contact 2 - Address

Parent/Guardian contact 2 - Mobile

Parent/Guardian contact 2 - Home telephone

Parent/Guardian contact 2 - Occupation and place of work

Parent/Guardian contact 2 - Work telephone

Parent/Guardian contact 2 - Email adress

Additional emergency contact - Name

Emergency contact priority

Additional emergency contact - Relationship to student

Additional emergency contact - Mobile

Additional emergency contact - Home telephone

Additional emergency contact - Work telephone

Agreement

Name of person completing form *

Relationship to student *

Email *

Signature *

Undo

Clear

Write your signature above the line

Date *