Transcript Document

PATEA AREA SCHOOL – ENROLMENT FORM
Section One – Personal Details
Surname:
First & Middle
Name:
Date of Birth::
Year Level:
Gender:
Male Female
NZ Resident?:
Ethnic Origin:
Yes No
Iwi:
Current Address:
Birth Certificate
Supplied?
(compulsory for new
entrants)
Immunisation
Certificate?
Yes No
Yes No
(desirable for
new entrants)
Section Two – Parent/Caregiver Details
Caregiver One
Caregiver Two
Full Name:
Full Name:
Address:
Address:
Circle One: Mother/Father/Grandparent/Guardian
Phone No:
Work Phone No:
Mobile No:
Circle One:
Mother/Father/Grandparent/Guardian
Phone No:
Work Phone No:
Mobile No:
Emergency Contact One
Home Phone No:
Work Phone No:
Mobile No:
Known To Child As:
Emergency Contact Two
Home Phone No:
Work Phone No:
Mobile No:
Known To Child As:
FOR OFFICE USE ONLY
Enrolment No
First Attendance
Generic Permission
NSN No
Entered in ENROL?
Yes/No
PATEA AREA SCHOOL – ENROLMENT FORM
Section Three– Schooling
Previous School:
Kindergarten
Previous Class:
Pre-School Education (please name)
Kohanga Reo
Play Centre
Other
Did your child attend one or more ECE services in the six months prior to starting school?
How many hours per week did they attend?
Yes/No
Section Four – Sibling Details
Please list brother/sister information below:
Full Name:
Date of
Birth:
School Attending:
Full Name:
Date of
Birth:
School Attending:
Full Name:
Date of
Birth:
School Attending:
Full Name:
Date of
Birth:
School Attending:
Full Name:
Date of
Birth:
School Attending:
Section Five – The Privacy Act
Authorisation:
I/We give permission for this school to use this recorded information n the student for educational and
1 school purposes which are in the student’s interests eg: school reports, testimonials, notice of success
in school newsletters and other publicity.
I/We give our permission for staff to obtain relevant educational information on the student from the
2
previous school.
In the case of an accident requiring medical treatment I/we give permission for a staff member to
3
transport our child to a medical centre if necessary.
I/We give permission for our child to be transported in a vehicle driven by a staff member for purposes
4
such as field trips.
I agree that my child’s image may be used from time to time in school publications eg: newsletters,
5
school website etc
Yes / No
Yes / No
Yes / No
Yes / No
Yes / No
DECLARATION:
I/We agree to:
1
2
Accept the regulations which are given by the Principal and the Board of Trustees eg: wearing of correct
uniform
Pay any fees which may be fixed from time to time by the Board of Trustees
Signed: _______________________________________________________ Dated: ___________________________
PARENT / CAREGIVER SIGNATURE
PATEA AREA SCHOOL – ENTRANCE INFORMATION
Entrance information is to be completed at the time of enrolment.
To ensure that we have the most suitable programmes in place we spend this term seeking as much information as
possible about individual students and their abilities, interests and areas of special needs. Please assist us by
completing this form and returning it to Patea Area School office staff.
Please identify the areas in which you consider your child to have unusually high ability:
(tick all that apply)
Reading
Computer skills
Writing stories or poetry
Oral Language
Mathematics
Drawing
Dance and/or drama
Cultural knowledge
High values/ethics
Social skills/leadership
Foreign languages
Science
Other (please describe):
Identify any remedial programmes which you believe would benefit your child:
(tick all that apply)
Reading assistance
Spelling assistance
Mathematics assistance
Other (please describe):
Identify any specialist services that your child has been involved with:
(tick all that apply)
Resource teacher of reading
Children & Young Persons
RTLB
Counsellor
Hospital
Educational Psychologist
SPELD
Speech/language therapist
Other (please describe):
Please describe any educational concerns you have about your child:
HEALTH: Please note any problem areas
Speech:
Sight:
Hearing:
Medication:
Any other problems: