Title Page
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Checked in by (Staff Member)
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Room Number Upon Check In
Student Details
Personal Details
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Full Name:
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Preferred Name:
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Phone Number:
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Email (That you check often):
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Date Of Birth
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Do you have any medical condition/s
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What medical condition/s do you have?
University/Tertiary Education Provider Details
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Name of University of Tertiary Education Provider
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Student ID Number with University or Tertiery Education Provider
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Course Name/Field of Study
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Photo of Student ID
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Photo of Student (For Safety and Security)
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Are you an international or domestic student?
Emergency Contact
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Emergency Contact Name
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Emergency Contact Phone Number
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Emergency Contact Relationship
Declerations
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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
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Please sign if you agree
