Online – Enrolment – Birkdale North School

Student Details

Student's Legal First Name

Student's Legal Last Name

Student's Preferred First Name

Student's Preferred Last Name

Date of Birth

Gender

Male

Female

Current Year Level Optional

Eldest Child at School Optional

Current School Optional

Home Address

Street Address

Address Line 2

Post Code

Suburb

City

Ethnicity

Iwi/Hapu

Affiliation

Ethnic Group/s

Language Spoken at Home

Country of Birth

Nationality

Parent/Caregiver Details (1)

Name

Primary Caregiver

Yes

Relationship to Student

Home Address

Same as Student Home Address

Street Address

Address Line 2

Post Code

Suburb

City

Country

Occupation

Home Phone

Work Phone

Mobile Phone

Parent/Caregiver Details (2)

Name

Primary Caregiver

Yes

Relationship to Student

Home Address

Same as Student Home Address

Street Address

Address Line 2

Post Code

Suburb

City

Country

Occupation

Home Phone

Work Phone

Mobile Phone

Emergency Contact (1)

Name

Relationship to Student

Home Address

Same as Student Home Address

Street Address

Address Line 2

Post Code

Suburb

City

Country

Home Phone

Work Phone

Mobile Phone

Emergency Contact (2)

Name

Relationship to Student

Home Address

Same as Student Home Address

Street Address

Address Line 2

Post Code

Suburb

City

Country

Home Phone

Work Phone

Mobile Phone

Health

Allergies

Medication

Hearing

Vision

Speech

Other Health Issues

Special Learning and Behavioural Needs

Immunisation

Yes

Medical Center Name

Doctor's Name

Phone

Custody/Access Arrangements

Court Order Issued

Yes

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

Additional Fields

Documents

Proof of in zone address
Council rates, water care, electricity bill etc.

Immunisation Documents

Student's Passport
If student is not a New Zealand citizen

Student's Birth Certificate/Passport
If student is a New Zealand citizen

Parent's Passport
If student is not a New Zealand citizen

Parent's Visa
If student is not a New Zealand citizen

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

Online – Enrolment

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Term Dates 2020