Holy Family Catholic School

External Therapist Registration Form

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External Therapist Registration Form

Title *

First Name *

Last Name *

Date of Birth *

Therapist's Mobile Number *

Therapist's Email Address *

Type of Therapy *

Company Name *

Company Address *

Street address *

City *

State *

Postcode *

Is the child in the School (Reception to Year 6) or Early Learning? *

SchoolEarly Learning

Please consider the times below when proposing sessions:

School Starts	8:50am
Recess	11:00am - 11:20am
Lunch	12:50pm - 1:30pm
School Ends	3:00pm

Proposed session: please provide student name/s, proposed day, time, duration and frequency)

Student Name

Day

Time

Duration

Frequency

Proposed Start Date *

In completing this form and all required SA WWCC records, I acknowledge that the School will use this information to facilitate screening through the Catholic Education Office and will share these records with the Archdiocesan Screening and Verification Authority in order to seek a Catholic clearance if necessary. *

Document Upload: WWCC *

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Please upload a copy of your WWCC (required)

Document Upload: RHHAN-EC

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Please upload a copy of your RHHAN-EC Certificate (if applicable)

Document Upload: Catholic Schools Clearance

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Please upload a copy of your Catholic Schools Clearance (if you have one)

Any Additional Comments

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