Online Enrolment Form

Term 4 ends on Tuesday 17th December at 1pm

Student Details
Student's Name*
First Last
Student's Preferred Name
First Last
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Other
If "Other", please specify*
Date First Started School
DD slash MM slash YYYY
Current Year Level

Optional
Previous 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
Date student entered NZ*
DD slash MM slash YYYY
NZ Resident*
- Yes
- No
Does student have a student visa?*
- Yes
- No
Does parent have a work permit?*
- Yes
- No
Are you a refugee?*
- Yes
- No
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*
Employer
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
Employer
Email
Home Phone
Work Phone
Mobile Phone
Emergency Contact (1)
Name*
Prefix First Last
Relationship to Student*
Home Phone
Mobile Phone*
Emergency Contact (2)
Name*
Prefix First Last
Relationship to Student*
Home Phone
Mobile Phone*
Civil Defence Emergency

Different people may need to be authorised to collect your child in the event of an emergency evacuation (earthquake, fire, flooding, tsunami, etc) as they need to be people who live or work close to school and would be able to get to school quickly and easily.

In addition to the people named above, the school may release the child to the following people in the event of a civil defence emergency.
Civil Defence Emergency Contact (1)
Name
Prefix First Last
Relationship to Student
Home Phone
Work Phone
Mobile Phone
Civil Defence Emergency Contact (2)
Name
Prefix First Last
Relationship to Student
Home Phone
Work Phone
Mobile Phone
Health
Allergies
Medication
Hearing
Vision
Speech
Other Health Issues
Special Learning and Behavioural Needs
Student interests, hobbies etc
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: 8 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: 8 MB.
Student's Birth Certificate/Passport*
If student is a New Zealand citizen
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Passport*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Visa*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Parent's Passport*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Parent's Visa*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Immunisation Documents*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Additional Fields
Place in Family
(e.g 1 of 2)
Other Children attending this school (now)
Other Children attending this school (in the future)
Permissions/Agreements
Education Outside the Classroom*
I give permission for my child to join in class trips that arise as part of the classroom programme. Individual permission will be sought for overnight trips and excursions in high-risk situations.
- Yes
- No
Publication Permission*
I give permission “For published mention/acknowledgement of my child”, “For publication of my child’s school work”, “To use photographs of my child while taking part in various activities at school. These items could appear on our website or on promotional or other forms of media eg newspaper, TV, etc”.
- Yes
- No
Medical Emergencies*
I understand that the school will take action on my behalf in case of sudden illness or injury and I will reimburse the school of any associated costs. School personnel may administer Pamol/Panadol if considered appropriate.
- Yes
- No
Information and Records*
In terms of the privacy act, I understand that the information on this form is collected to form part of the essential information the school holds on my child. The records made from this information may be viewed on request at the school. I approve forwarding of information when my child transfers to another school. I further approve the forwarding of my child’s name and address to a potential Intermediate or Secondary School
I agree.
School Policies*
I agree to abide by school policies.
By signing this below, I confirm that the information given in this form is true, complete and accurate.
Full Name*
Date*
DD slash MM slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Student Details

Ethnicity

Parent/Caregiver Details (1)

Parent/Caregiver Details (2)

Emergency Contact (1)

Emergency Contact (2)

Civil Defence Emergency

Civil Defence Emergency Contact (1)

Civil Defence Emergency Contact (2)

Health

Custody/Access Arrangements

Early Childhood Education

Documents

Additional Fields

Permissions/Agreements

Contact

Quick Links

2024 Term Dates