Check In Form

• Checked in by (Staff Member)

• Room Number Upon Check In

Personal Details

• Full Name:

• Preferred Name:

• Phone Number:

• Email (That you check often):

• Date Of Birth

  Date

• Do you have any medical condition/s

  Yes

  No

• What medical condition/s do you have?

University/Tertiary Education Provider Details

• Name of University of Tertiary Education Provider

• Student ID Number with University or Tertiery Education Provider

• Course Name/Field of Study

• Photo of Student ID

  Media

• Photo of Student (For Safety and Security)

  Media

• Are you an international or domestic student?

  Domestic

  International

Emergency Contact

• Emergency Contact Name

• Emergency Contact Phone Number

• Emergency Contact Relationship

Declerations

• By signing below you agree that you understand and will abide by all clauses set out in the Residential Agreement, Code of Conduct and House Rules

• Please sign if you agree

  Sign