For office use - Year 7 / 8 Room ______
Student Details
Date of Birth
Address __________________________
Surname _________________________________
Legal Surname ____________________________
Copy of NZ Birth
Certificate OR
1st Name ________________________________
passport to be
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 _______________________________ 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 -

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

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.


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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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