Online Enrolment Form

Pupil
Name*
First Last
Preferred First Name
Preffered Surname
Gender*
- Male
- Female
Date of Birth*
Date Format: MM slash DD slash YYYY
Place in Family (eg. 1 of 2)
Home Address*
Street Address Address Line 2 City Suburb ZIP / Postal Code Country
Rural Emergency No.
Previous Education
Previous School/Centre
Current Class/Year Level
Eldest Child at This School
School Address
Street Address Address Line 2 City Suburb ZIP / Postal Code Country
Ethnicity
Ethnicity (1)*
Ethnicity (2)
Ethnicity (3)
Iwi/Hapu (1)
Iwi/Hapu (2)
Home Language*
Residency/Citizenship*
- Yes
- No
Date of NZ entry*
Date Format: MM slash DD slash YYYY
Country of Birth*
Country

Parents / Caregivers
Parent/Caregiver (1)
Name*
Prefix First Last
Relationship to Pupil*
Address*
Same as Pupil

Street Address Address Line 2 City Suburb ZIP / Postal Code Country
Country of Birth*
Country
Workplace/Hrs
Occupation
Home Phone No*
Mobile Phone No*
Work Phone No
Email*
Parent/Caregiver (2)
Name*
Prefix First Last
Relationship to Pupil*
Address*
Same as Pupil

Street Address Address Line 2 City Suburb ZIP / Postal Code Country
Country of Birth*
Country
Workplace/Hrs
Occupation
Home Phone No*
Mobile Phone No*
Work Phone No
Email*
Emergency Contacts
Emergency Contact (1)
Name*
Prefix First Last
Relationship to Pupil*
Home Phone No*
Mobile Phone No*
Emergency Contact (2)
Name*
Prefix First Last
Relationship to Pupil*
Home Phone No*
Mobile Phone No*
Doctor
Doctor's Name
Phone*
Dental Clinic
Name of Legal Guardian/s

Custody Access
Court Order Issued?*
- Yes
- No
- N/A
Please Attach Custody Document
Drop files here or

Accepted file types: jpg, png, pdf.
Extra copy of school report to:
Address
Street Address Address Line 2 City Suburb ZIP / Postal Code Country

Other
Members of your family likely to attend this school in the future.
Name
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Name
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Name
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Additional Information
Declaration
Declaration*
I have read and accept the privacy statement and parent declarations on the reverse of this form.
Please Write Your Name as Form of Digital Signature*
First Last
Date*
Date Format: MM slash DD slash YYYY
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Pupil