Enrolment

Details about your Child

Child's Legal Surname *

Child's Legal First Names (include middle names please) *

Child's Preferred Name *

Child's Physical Address *

Child's Date of Birth *

Child's Gender *

Male

Female

Name of previous school / kindy / education centre

Approximately how long did they attend their previous school / kindy / education centre? *

Child's Current Year Level *

Country of Birth *

Ethnicity *

State Other

Iwi - Please state if NZ Māori selected

Language/s spoken at home *

Place in Family *

Date expected to start Horotiu School *

Parent Details

Mother's Name (First name and Surname) *

Mother's Email

Mother's Home Phone Number

Mother's Mobile Number

Mother's Occupation

Mother's Physical Address *

Same as child

Different from child (please fill in address below)

Mother's Physical Address

Mother's Postal Address (if different)

Father's Name (First name and surname)

Father's Email

Father's Home Phone Number

Father's Mobile Number

Father's Work Number

Father's Occupation

Father's Physical Address *

Same as child

Different from child (please fill in address below)

Father's Physical Address

Father's Postal Address (if different)

Additional Caregiver's Name (First name and surname)

Additional Caregiver's Email

Additional Caregiver's Home Phone Number

Additional Caregiver's Mobile Number

Additional Caregiver's Work Number

Additional Caregiver's Residential Address

Additional Caregiver's Postal Address

Emergency Contact Details

Please provide at least one other contact not already mentioned on this form that we can ring if we are unable to get hold of anyone else.

First Emergency Contact Name (First and last) *

Relationship to Child

First Emergency Contact Number *

Second Emergency Contact Name (First and last)

Relationship to Child

Second Emergency Contact Number

Third Emergency Contact Name (First and last)

Relationship to Child

Third Emergency Contact Number

Important Information

Doctor's Name and Medical Centre *

Medical Centre's Phone Number *

Medical Information *

My child has no medical issues

Allergies (specify below)

Medical Condition (specify below)

Medication Required (specify below)

Medical Information

Please specify medical condition and or medication required

Health Statement - All students should have completed their Childhood Immunisation Programme before *

My child has been immunised

I choose not to immunise my child

Does your child have a special need or require special learning support. (Please list e.g. ADHA, ADD *

If YES, please identify

Has your child received specialist support, e.g. SPELD Assessment, RTLB, ORRS. *

Yes

No

If YES, please identify

Are there any court/custody documents relating to your child? (If yes, please outline below and prov *

Yes

No

Custody Details

My child has permission to attend Kapa Haka *

Yes

No

My child is confident in water *

Yes

No

Can sunscreen be applied at school? *

Yes

No

Are there any pre-school children who will come to our school in the future? Please provide full names and dates of birth.

Is there anything else that you think we need to know about your child that will help them be successful at our school?

To the best of my knowledge the information contained in this enrolment form is true and correct. Horotiu School requires accurate information in order to communicate with parents/caregivers, to determine appropriate educational and pastoral support needs and to complete statistical returns.

The Privacy Act 1993 places rules on the collection, use, storage and access of information that is received at enrolment, and from student academic records. All reasonable care is taken in the collection, storage and security of this information. From time to time it needs to be updated. Individuals have the right of access to personal information through the Principal, who is the Horotiu School Privacy Officer. At the discretion of the Principal, under section 76 and section 77 of the Education Act 1989, this information may be shared with the following groups of professionals on a need to know basis: School staff, Specialist Education services, Public Health Nurse and Doctors, Ministry of Education, Ministry of Health, Oranga Tamariki and their Family service, Police, other professionals approved by the Principal. If you do not wish personal information to be released then contact should be made with the Principal.

Enrolment Declaration

Should the need arise, I give permission for my child to receive the recommended dosage of Paracetamol *

Click here to read info

Yes

No

I am happy for my child to see the Dental Therapist. *

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Yes

No

If required, I am happy to have my child seen by the Hearing & Vision Technician. *

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Yes

No

If required, I am happy to have the Public Health Nurse see my child. *

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Yes

No

I am happy to have the school administer sunscreen and basic first aid to my child. *

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Yes

No

I give my general approval for the student enrolled to participate in off-site programmes learning, within his or her normal classroom time allocation and approved by the Principal. These are events related to the curriculum, either on-site in the school grounds or off-site events in the local community which are in lower risk environments. *

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Yes

No

I give permission for my child to attend the Horotiu School Aquatics Programme as part of the curriculum. *

Click here to read info

Yes

No

I give permission for photos and videos of my child taken as part of our school-wide learning to be shared with our community, e.g. in the school yearbook, on our website, on Dojo. Children’s full names will never accompany any visual images on the internet. *

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Yes

No

I give permission for my child’s photograph to be used for promotional purposes outside the school e.g. newspaper articles, pamphlets, etc. *

Click here to read info

Yes

No

I accept responsibility for any expenses incurred in obtaining treatment for this child in an emergency situation e.g. ambulance costs *

Click here to read info

Yes

No

I am happy for my child to use the school filtered internet and email as a tool for their learning while they attend Horotiu School. *

Click here to read info

Yes

No

Zone Declaration

Type of Enrolment - tick as many as apply *

In-Zone Enrolment (See declaration below)

Out of Zone Enrolment

Sibling at Horotiu School (current or past)

Parent an ex-student of Horotiu School

Parent Board employee of Horotiu School

In-Zone Declaration

I have read and understand the Ministry of Education rules regarding in-zone addresses (available at the school office). I confirm that the address I have provided on this form is the usual place of residence for this child and I will advise the school of any subsequent change of address. I have provided proof of address.

Yes

Supporting Paperwork You Will Need to Provide

If your child is STARTING SCHOOL IN NEW ZEALAND FOR THE VERY FIRST TIME you will need to provide the following supporting documents to the school. They are:-

1) Proof of your child's I.D. (birth certificate or passport)
2) Students born outside New Zealand: copy of Passport and Citizenship / Residency / Visa / Immigration documents
3) Proof of your address (utility bill or rental/sale agreement) In-zone enrolments only.
4) Immunisation Certificate

If your child is TRANSFERRING FROM ANOTHER NEW ZEALAND SCHOOL you will need to provide the following supporting documents, if applicable.
They are:-

1) Students born outside New Zealand: copy of Passport and Citizenship / Residency / Visa / Immigration documents.
2) Proof of your address (utility bill or rental/sale agreement) In-zone enrolments only.
3) Immunisation Certificate

For an enrolment to be accepted, these documents must be supplied directly to our School Office in hard copy (the office will photocopy your documents).

Parent Confirmation *

Agree

Details about your Child

Parent Details

Emergency Contact Details

Important Information

Consent under the Privacy Act 1993 and Declaration by Parent(s) / Guardian(s)

Enrolment Declaration

Zone Declaration

Supporting Paperwork You Will Need to Provide