Enrolment Form

Student Details

Student's Name*

First Last

Student's Preferred Name

First Last

Date of Birth*

Gender*

Male
Female
Other

If "Other", please specify*

Current Year Level

Optional

Eldest Child at School

Optional

Current School

Optional

Address*

Street Address Address Line 2 City Suburb Post Code

Ethnicity

Iwi/Hapu

Affiliation

Ethnic Group/s*

Language Spoken at Home*

Country of Birth*

Country

Nationality*

Country

Parent/Caregiver Details (1)

Name*

Prefix First Last

Primary Caregiver*

Yes
No

Relationship to Student*

Address*

Same as Student Home Address

Street Address Address Line 2 City Suburb Post Code

Occupation*

Email*

Home Phone

Work Phone

Mobile Phone*

Parent/Caregiver Details (2)

Name

Prefix First Last

Primary Caregiver

Yes
No

Relationship to Student

Address

Same as Student Home Address

Street Address Address Line 2 City Suburb Post Code

Occupation

Email

Home Phone

Work Phone

Mobile Phone

Emergency Contact (1)

Name*

Prefix First Last

Relationship to Student*

Address*

Street Address Address Line 2 City Suburb Post Code Country

Home Phone

Work Phone

Mobile Phone*

Emergency Contact (2)

Name*

Prefix First Last

Relationship to Student*

Address*

Street Address Address Line 2 City Suburb Post Code Country

Home Phone

Work Phone

Mobile Phone*

Health

Allergies

Medication

Hearing

Vision

Speech

Other Health Issues

Special Learning and Behavioural Needs

Immunisation*

Yes
No

Medical Center Name*

Doctor's Name*

Phone*

Custody/Access Arrangements

Court Order Issued*

Yes
No

Court Order Documents

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Access Arrangement

Early Childhood Education

Prior-Participation in Early Childhood Education

Please select (up to 3 services) for the last Early Childhood Education service(s) attended in the six months prior to starting school

Kohanga Reo
Play Center
Kindergarten or Educations and Care Centre
Home based service
Playgroup
The Correspondence School – Te Aho Te Kura Pounamu

Hours per Week at Kohanga Reo*

Hours per Week at Play Center*

Hours per Week at Kindergarten or Educations and Care Centre*

Hours per Week at Home based service*

Hours per Week at Playgroup*

Hours per Week at The Correspondence School – Te Aho Te Kura Pounamu*

Documents

Proof of in zone address*

Council rates, water care, electricity bill etc.

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Student's Birth Certificate/Passport*

If student is a New Zealand citizen

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Student's Passport*

If student is not a New Zealand citizen.

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Parent's Passport*

If student is not a New Zealand citizen.

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Parent's Visa*

If student is not a New Zealand citizen.

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Immunisation Documents*

Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 16 MB.

Additional Fields

Privacy & Policy

Permissions

I give permission for my child’s image to be used where appropriate. Eg. newsletter, school website, classroom displays etc.
I give permission for the school staff to administer general first aid. Staff are not permitted to give any medication without a separate signed consent form.
I give permission for my email to be used for newsletters, notifications, fundraising, initiatives and emergencies such as evacuations and lockdowns etc.

Privacy Statement
The information collected will be used by the school for enrollment and forms an essential part of the information held by the school on your child. The records made from this information may be viewed on request at the school. The information collected may be disclosed to appropriate education, health and welfare authorities and for data-gathering purposes by the New Zealand Ministry of Education, in accordance with the principles of the Privacy Act. It will not be disclosed to any other person or agency unless such disclosure is authorised or required by law.

Parent Declaration
I agree that the school will take action on my behalf in case of sudden illness or injury, to abide by the school’s policies, that my child’s work and image may be used in accord with the school’s online publishing policy/procedures and that the school may forward my child’s name and address to a potential intermediate or secondary school. All information that I have provided is true and correct.

Signature

By signing this below, I confirm that the information given in this form is true, complete and accurate.

Full Name*

Date*

CAPTCHA

Name

This field is for validation purposes and should be left unchanged.