| Student details | |||
| Family name: | |||
| First name: | |||
| Preferred name: | |||
| Date of birth: (date/month/year) | Nationality (as shown in passport): | ||
| Passport number: | Passport expiry: | ||
| Visa type/status: | |||
| Date of first entry into New Zealand: | |||
| Address (in home country): | |||
| Phone (in home country): | |||
| Details of parent/legal guardian enrolling student | ||||
| Family name: | ||||
| First name: | ||||
| Preferred name: | ||||
| Date of birth: (date/month/year) | Nationality (as shown in passport): | |||
| Passport number: | Passport expiry: | |||
| Address (in home country): | □ Tick if same as student or enter below | |||
| Home phone: | Cell phone: | |||
| Email: | ||||
| Enrolment | |
| Length of enrolment: |
| Insurance |
| Your child must have medical and travel insurance to cover the period of study, from leaving home to returning home. Please provide copies of these insurance policies in English. |
| Health | ||||||
| Vaccinations (please list OR provide a vaccination certificate in English): | Date received: | |||||
| Has the student had a Tetanus injection in the last 5 years? | Yes | No | ||||
| Has the student been in contact with any contagious diseases within the last 3 months? | □ | Yes | □ | No | ||
| If yes, please give details: | ||||||
| Medical conditions (please list): | Enter any medication required: | |||||
| Allergies (please describe): | Enter any medication required: | |||||
| Does the student suffer from any disability? If yes, please give details: | Yes | No | ||||
ACCOMMODATION
| Students under 10 years old | |
| Students under 10 years of age must live with a parent or legal guardian, or in an approved school hostel. | |
| My child will be living with me (parent/legal guardian). | Signed: |
| Students 10–17 years old | |
| Students aged 10–17 years must live with a parent or legal guardian, or a residential caregiver. | |
| My child will be living with me (parent/legal guardian). | Yes/No |
| My child will be living with a designated caregiver (relative or close family friend designated in writing by me, the parent/legal guardian) | Yes/No |
| My child will be living with a homestay caregiver. | Yes/No |
| Group students | |
| Group students under 10 years of age must live with a parent or legal guardian, or in an approved school hostel. | |
| Parent/legal guardian living with student in New Zealand | ||||
| Family name: | ||||
| First name: | ||||
| Preferred name: | ||||
| Date of birth: (date/month/year) | Nationality (as shown in passport): | |||
| Passport number: | Passport expiry: | |||
| Visa type/status: | ||||
| Date of first entry into New Zealand: | ||||
| Address (in home country): | □ Tick if same as student or enter below | |||
| Home phone (in home country): | Cell phone: | |||
| Email: | ||||
| Address (in New Zealand): This is the address where you and the student will be living. | ||||
| Home phone (in New Zealand): | Cell phone: | |||
| Designated caregiver living with student in New Zealand | |||
| Relationship to student: | |||
| Family name: | |||
| First name: | |||
| Preferred name: | |||
| Is the designated caregiver a New Zealand citizen or resident? | |||
| □ Yes (keep answering from “email” below) □ No (if no, please complete details below) | |||
| Date of birth: (date/month/year) | Nationality (as shown in passport): | ||
| Passport number: | Passport expiry: | ||
| Visa type/status: | |||
| Date of first entry into New Zealand: | |||
| Address (in home country): | |||
| Home phone (in home country): | Cell phone: | ||
| Email: | |||
| Address (in New Zealand): This is the address where the designated caregiver and the student will be living. | |||
| Home phone (in New Zealand): | Cell phone: | ||
ABOUT THE STUDENT
| General information |
| Briefly tell us about your aspirations for your child while they live in New Zealand, e.g. reasons for coming to New Zealand. |
| Briefly, tell us about your child’s interests e.g. sports, cultural, music. |
| Briefly tell us what your child enjoys most when at school e.g favourite classes, activities in class. |
| Education | |
| Does your child have any special learning needs? | □ Yes (if yes, please describe below) □ No |
| Previous school(s) in New Zealand (please answer if applicable) | |
| School name: | Dates enrolled/attended: |
DECLARATIONS
| Please read these statements carefully and ensure you understand them. | ||||
| I have been informed about and received a summary of the Code of Practice for International Students. | □ | Yes | □ | No |
| I have received a copy of the school’s Guide for International Students. | □ | Yes | □ | No |
| I understand the costs involved with enrolment, and the school’s policy regarding fee refunds and protection. | □ | Yes | □ | No |
I confirm all the information contained in this enrolment application is true and correct to the best of my knowledge.
I acknowledge that if I have provided false information or withheld relevant information, the school may terminate the enrolment.
I will inform the school if there are any changes to the details of this application.
Parent/legal guardian name:
_________________________________________________
Parent/legal guardian signature:
_________________________________________________
Date: ____________________________________________
Parent/legal guardian name:
_________________________________________________
Parent/legal guardian signature:
_________________________________________________
Date: ____________________________________________
DOCUMENTATION
| Please provide the following documents (copies or originals) with this application: | |
| □ | Student’s passport and visa details |
| □ | Passport of person who will be living with the student and visa details |
| □ | Designated caregiver agreement |
| □ | Immunisation certificate (in English) for student |
| □ | Tuition Agreement |
| □ | Evidence of medical and travel insurance |
| □ | EOTC consent form |
| □ | Digital Citizen Responsible Use Agreement |