Surname:	Click or tap here to enter text.

Given Names:	Click or tap here to enter text.

Residential Address:	Click or tap here to enter text.

Postal Address:	Click or tap here to enter text.

Email:	Click or tap here to enter text.

ACMR Number:	Click or tap here to enter text.

NOTE: If you do not have an ACMR number, you will need to provide the following two documents.

Statement by Church Authority Relating to Professional Standards

Personal Declaration Relating to Professional Standards

Reason for Visit (e.g. Ordination, Supply, Retreat, etc.): Click or tap here to enter text.

Date(s) of Event/Activity in the Diocese:	Click or tap here to enter text.

Exact arrival Date into Western Australia: Exact Departure Date from Western Australia:

Click or tap here to enter text.	Click or tap here to enter text.

How many days in total will you be in Western Australia? Click or tap here to enter text.

Please provide a copy of your current Working With Children Card or equivalent.

To gauge if you require a Western Australian Working With Children Card?

Q1.	In the past 12 months, how many days in total have you spent inside Western Australia? ____ day/s.

Q2.	Were any of these days for a National event or tour?

☐ Yes {If ‘Yes’ you need to apply for a W.A. WWCC}.

☐ No {If ‘No’ go to Q3}.

Q3.	Is the total number of days you will be in Western Australia for this forthcoming visit, added to the

number of days answered in Q1, equal to, or less than, 14 days?

☐ Yes {If ‘Yes’ you do not need to apply for a W.A. WWCC}.

☐ No {If ‘No’ you are by W.A. law required to apply for a W.A. Working With Children Card}.

If you require clarification please visit the Western Australian Working With Children website https://workingwithchildren.wa.gov.au and type exemptions into search or contact the Chancellor chancery@diocese-geraldton.org