it | ¢- Declaration
sn ig fase miseaing information serous oes,
ote completed byte sttent guaran
teat
«wil provide appropiate welfare rangement forthe noinatng
stent
«the stuert quran nominated inthis fom is rare a Stutet
Cuan is, te inating student wi ei Austra with
that quran, and wi not reside wth nye Stet Guan
vis der parent regal custodian,
«| azknonledga my respon forging appre
cconmoiaon and ave oad fom Australien beta of he
‘inating tude under he ae of 18.
{ema tat orton 852 wl be imposed n teva ct
tte ning suet under he age 18 and wi ene thst
propa welrearargonts rn place and aired ta
ties.
Signature of
student
‘guardian
Date
Wie strongly acise that you kp copy ofthis form andl
attachments for your records.
27 Tobe complet bye parents recut erating
stunts under the ae of 18
ele tt
«the infomaton sul on orth fom coe
«nae ataced al documentary aiden as eed
«+ |amawae tat ust immed ate the Depart
bear aware tat ay Iforatin proved ins frm sincaert
ae erels a change nthe ninaing suet cresances
‘hats relent this ppc tary ie.
«Ihave edhe infeatn cared nf 1442 Privacy notice
+ turer Oeprtnet acl, an es
persona fomaten (nung tometiefomaten
‘ens kYomat) 2 ound nfo 14425 Privacy Note.
Signature of
student
(over the
age of 18)
bate
i
‘signatures of parents/egal custodians
fire nominating students under the 298 2 1)
Cae ret a eg store mt is eaahOy
samen es
wena 20am
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