Parent/guardian details
Name of child: Ben Adam
Parent(s)/Guardian(s) details
Parent/Guardian 1
Name: Graeme Good Country of birth: Australia Language/s spoken: English Occupation: Computer Software Specialist Is the work undertaken by this person paid or voluntary? PaidParent/Guardian 2
Name: Country of birth: Language/s spoken: Occupation: Is the work undertaken by this person paid or voluntary?Do either (or both) parent(s)/guardian(s) have a disability? No
Custody of the Child
Have any orders been made by any court regarding your child? Yes If “No”, is there any dispute/s concerning custody of the child? No If “YES”, please provide details of Guardianship and Custody, and Terms of any specific Custody or Access provision (if applicable): Permanent custody of Ben with open visitation rights of family.
Enrolling parent/guardian's initials:
Date: