Changes to contact details

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The Department of Education, through Strathpine 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. The information will not be given to any other person or agency unless consent is provided.

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Student surname *

Student given name *

Parent/Guardian contact 1 - Name *

Parent/Guardian contact 1 - Address *

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 - Mobile *

Parent/Guardian contact 1 - Email address *

Parent/Guardian contact 2 - Name

Parent/Guardian contact 2 - Address

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 - Mobile

Parent/Guardian contact 2 - Email address

Additional emergency contact priority 1 - Name *

Additional emergency contact priority 1 - Relationship to student *

Additional emergency contact priority 1 - Home telephone

Additional emergency contact priority 1 - Work telephone

Additional emergency contact priority 1 - Mobile *

Additional emergency contact priority 2 - Name

Additional emergency contact priority 2 - Relationship to student

Additional emergency contact priority 2 - Home telephone

Additional emergency contact priority 2 - Work telephone

Additional emergency contact priority 2 - Mobile

Additional emergency contact priority 3 - Name

Additional emergency contact priority 3 - Relationship to student

Additional emergency contact priority 3 - Home telephone

Additional emergency contact priority 3 - Work telephone

Additional emergency contact priority 3 - Mobile

Name and contact number of person completing form *

Please note that no alterations will be made to your stored contact information until we have made a phone call to verify any changes as indicated. I confirm that the above information is correct and understand that these details will be verified by the school before information is changed in school records.

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