For office use - Year 7 / 8 Room ______ PAPATOETOE INTERMEDIATE ENROLMENT DETAILS 2014 Student Details Date of Birth Address __________________________ ___________ Surname _________________________________ _________________________ Legal Surname ____________________________ Copy of NZ Birth Certificate OR _________________________ 1st Name ________________________________ passport to be attached Postcode __________ 2nd Name ________________________________ Students NOT N.Z. Preferred Name ___________________________ born must also Phone ______________________ attach their birth Names of any brothers or sisters who are or have certificate along with the Passport attended Papatoetoe Intermediate – Email you would like school correspondence to Name Year attended _____________________________ _______ ___________________________________ _____________________________ _______
Ethnicity
Ethnicity _______________________________ Main language spoken at home ________________________
Country of Birth ___________________________________
If Maori please state your Iwi Affiliation ________________________________________
Mother/Guardian Details [if not Mum please indicate relationship e.g. Step Mother, Aunt, Guardian] ________________________ Title ____ First Name _______________________ Surname _______________________________________
Occupation ____________________________ Work Phone _______________ Cel __________________________
Address – [if different from above- please include Postcode] __________________________________________________
_____________________________________________________________________________________________
Father/Guardian Details [If not Dad please indicate relationship e.g. Step Father, Uncle, Guardian] _______________________ Title ____ First Name _______________________ Surname _______________________________________
Occupation ____________________________ Work Phone _______________ Cel __________________________
Address – [if different from above- please include Postcode]] __________________________________________________
_____________________________________________________________________________________________
Emergency Contact Details [Please indicate relationship e.g. Friend, Neighbour, Grandparent] ____________________________ Title ____ First Name _______________________ Surname _______________________________________
Home phone ____________________ Work Phone _______________ Cel _____________________________
Previous School ______________________________________________________
Medical Details
Doctor’s Name ________________________________________ Phone _____________________ Medical Conditions and associate procedures [if any] ______________________________ ______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Please supply details of any condition that may call for special steps to be taken _________________________________ _____________________________________________________________________________________________
_____________________________________________________________________________________________
Access Restrictions
Is anyone to be denied Access to your child?
If yes please state who and supply any documentation.
______________________________________________________________________________________________ ___________________________________________________________ Documents are attached – Yes/No If NOT New Zealand born please answer the following questions. Date of arrival in New Zealand ______________________________________
Can we administer the following if required?
Permission to -
INFORMATION PRIVACY – ▪ The personal information provided in this application will be used for school management purposes, and appropriate statistical returns.
▪ Photos of students’ and their work may be published on the school website.
▪ Pupils change school and are also promoted to secondary schools. Information is passed on to the new schools.
▪ I/we agree to pay for any charges the board may wish to make for any specific school activities.
Signed _______________________________________________ Parent/Guardian ADDRESS OF CONVENIENCE – People who use false addresses or ‘addresses of convenience’ to get into their preferred school ‘in zone’ –
when they are NOT – will have their children’s enrolment cancelled.
CHRONIC MEDICINE BENEFIT APPLICATION FORM APPLICATION INSTRUCTIONS (please complete this application as follows) The application must be completed in black ink. Please print clearly and legibly. One application form must be completed per patient. Kindly take note of the clinical entrance criteria for the various chronic conditions. These are detailed on pages 6 to 8. Certain entry
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