Castlecliff School Student Enrolment Form

Legal Surname: / Legal First Name: / Middle Name(s): / Preferred Name:
Date of Birth: / Gender: M/F / NSN:

CASTLECLIFF SCHOOL STUDENT ENROLMENT FORM

Additional Information:

FTE: / Type of Student: Regular/Other
Other: / Enrolment Number: / School Year Level:
Yr 0/1/2/3/4/5/6
Previous School: / First Schooling Date: / Proposed Start Date Here: / Actual First Attendance:

Ethnicity Details:

1st Ethnicity: / 2nd Ethnicity: / Language at Home:
Iwi: / Iwi: / Iwi:
Born in New Zealand: Y/N / Country of Citizenship: / Date of Arrival in NZ:
Verification Document: / Document Serial Number: / Document Expiry Date:

Group Membership

Room:

Tūāpapa
Junior Whānau
Whānau
Team Tama

/ House:

Hinengakau
Tama Upoko
Tupoho
Whanganui

/ Learning Notes:

RTLB
SLS
RT Lit
Jigsaw
Other:

General Details

Enrolment Priority: / Early Childhood Education:

Normal
Parent an Ex Student
Parent is Staff
Sibling at School

Home Based Service.

Kindergarten or Education & Care.

Kohanga Reo.

Playcentre.

Playgroup or Pacific Islands EC group.

TeAho o Te Kura Pounamu. (Correspondence School)

Extra MoE Details

ORS and Section 9

No Section 9, no ORS
ORS – High Level
ORS – Very High Level
Section 9 without ORS

/ Maori Learning Index:

Curriculum Taught in Maori 12.5-20 hours per week
Curriculum Taught in Maori 7.5-12.5 hours per week

Eligibility Criteria:

NZ Citizen
NZ Resident
Australian Citizen

Domestic Time-bound
28 Day Waiver
Extended 28 Day Waiver
MoE Approved

Primary Caregiver Details:

Name: / Relationship to Student: / Confidential:
Street Address: / Suburb: / Phone (Home): / Yes/No
City: / Post Code: / Phone (Cell): / Yes/No
Occupation: / Employer: / Phone (Work): / Yes/No

Status:

Legal Guardian: / Bill Payer / Emergency Contact / Voting Rights
Student’s Address / Notice to Recipient / Data Access / Denied Access

Secondary Caregiver Details:

Name: / Relationship to Student: / Confidential:
Street Address: / Suburb: / Phone (Home): / Yes/No
City: / Post Code: / Phone (Cell): / Yes/No
Occupation: / Employer: / Phone (Work): / Yes/No

Status:

Legal Guardian: / Bill Payer / Emergency Contact / Voting Rights
Student’s Address / Notice to Recipient / Data Access / Denied Access

Emergency Contacts:

Name: / Relationship to Student: / Address: / Phone:
Home:
Cell:
Home:
Cell:
Home:
Cell:

Custody Arrangements/Access Restrictions

Court documents required to uphold parental access restrictions:

Pre-School Age Family Members Living with Student:

Name: / DOB: / Gender:

Doctor’s Information:

Doctor’s Name: / Address: / Phone:
Medical Centre: / Medical Notes:

Medical Conditions and Allergies:

Condition: / Severity:

Contact Caregivers
Emergency Care Required
Low Risk
Moderate Risk

/ Medicine Held:
Refrigerated: Y/N / Hospitalization Required:
Details:

Medical Details

6 Week Immunisation / 3 Month Immunisation / 5 Month Immunisation
15 Month Immunisation / 4 Year Immunisation / Tetanus Date:
Parent Consents that in an Emergency School May Act on Behalf: Y/N / Parent Consents that School May Administer Pain Relief: Y/N / Comment:

Extra Student Notes/Information Provided:

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 school. I understand that the information held by the school can be accessed by government organisations investigating issues under the Vulnerable Children’s Act 2014. I approve the forwarding of information when my child transfers to another school. I further approve the forwarding of my child’s name and address on request to a potential intermediate school. I understand that the school will take action on my behalf in case of sudden illness or injury, and I agree and abide by school policies.

………………………………………………………………………………………………………………………….. (Parents/Legal Guardian’s Signature)