Parent/ Legal Guardian Details

(Please complete in full 􏰀 no abbreviations)
Centrelink Concession Card Details(Required)
DD slash MM slash YYYY

Student Details

Please add each student on a new line by pressing the '+' button
Student Information(Required)
First Name
Year Level

Parent / Guardian Declaration

Parent/Guardian Declaration I declare that:

- The card is in the name of the person responsible for fee payment;
- I will notify the school if my concession card status changes during the year.

I authorise:

- Nazareth College to use Centrelink confirmation eService to perform a Centrelink/DVA enquiry of my Centrelink or Department of Veteran's Affairs customer details and concession card status to enable Nazareth College to determine if I qualify for an educational rebate or service.
- Services Australia (the agency) to provide the results of that enquiry to Nazareth College.
I understand that:

- The agency will disclose personal information to Nazareth College including my name/payment type/payment status and concession card type and status to confirm my eligibility for the relevant educational concession.
- This consent, once signed, remains valid while I am a customer of Nazareth College unless I withdraw it by contacting Nazareth College or the agency.
I can get proof of my circumstances/details from the agency and provide it to Nazareth College so my eligibility for the relevant educational concession can be determined.
- If I withdraw my consent or do not alternatively provide proof of my circumstances/details, I may not be eligible for the concession provided by Nazareth College.
- I need to provide a copy of my health care card with this application form.
Declaration Acceptance(Required)
Max. file size: 8 MB.
Max. file size: 8 MB.

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