Te Urutanga Mai: Enrolment A copy of the following documents MUST accompany the enrolment form: Student’s birth certificate or passportImmunisation ReportThe most recent school reportIf born outside of New Zealand student resident permit/visa.Before submitting the form below, please make sure that the obligatory fields marked with * are filled in correctly. Enrolment Form Please enable JavaScript in your browser to complete this form.Student Details - Step 1 of 6Student DetailsLayoutYear Level *Year 9Year 10Year 11Year 12Year 13(Tick the year level which applies)Year applying for *LayoutStudent's Legal Surname: *(must be as it appears on a birth certificate or passport) Student's Legal First Name: *(must be as it appears on a birth certificate or passport) LayoutStudent's preferred name(if different from above)Preferred name(s) for school report: LayoutGender *MaleFemaleNon-BinaryDate of birth *DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920LayoutCountry of Birth: *Student's Phone: *LayoutPrevious School: *Language spoken at home: *Any sibling/s currently at Ngā Taiātea? *YesNoIf yes, please add the name of sibling(s) belowLayoutName of sibling/s currently at Ngā Taiātea: *Do they live at the same address? *YesNoEthnicity *MāoriPākehā/NZ EuropeanOtherlwi and Region if known *(up to 3 may be used)Other *LayoutRegistered Waikato Tainui Tribal Member? *YesNoMembership Number:Are there any special access/ custody orders that the kura should be aware of? *YesNoLayoutIf you answered 'Yes' to above, please explain and provide a copy of legal documentation. *File Upload *Has the student ever been stood down/suspended/excluded or expelled from school? *YesNoIf you answered 'Yes' to above, please provide further information. *Has the student had any attendance issues? *YesNoHas the student had a referral to RTLBSpecial EdTeacher AideCouncillorOranga TamarikiSpeech TherapistPlease provide the name(s) of the specialist(s) who are working with the student. NextResidence A: Main Caregiver(s) who student lives with all or most of the timeMother's DetailsTitleMrsMissMsOtherName *If not mother, please specify relationship to student *LayoutEmail address *Phone(mobile) *LayoutOccupationWork Phone NumberFather's DetailsTitleMrOtherName *If not father, please specify relationship to student *LayoutEmail address *Phone(mobile) *LayoutOccupationWork Phone NumberAddressResidential Address *Address Line 1CityState / Province / RegionPostal CodePostal Address (if different from residential)Address Line 1CityState / Province / RegionPostal CodeShared CareIs the student in shared care? *YesNoResidence B: Main Caregiver(s) who student lives with all or most of the timeMother's DetailsTitleMrsMissMsOtherName *If not mother, please specify relationship to student *LayoutEmail address *Phone(mobile) *Layout OccupationWork Phone NumberFather's DetailsTitle MrOtherName *If not father, please specify relationship to student *LayoutEmail address *Phone(mobile) *LayoutOccupationWork Phone NumberAddressResidential Address *Address Line 1CityState / Province / RegionPostal CodePostal Address (if different from residential)Address Line 1CityState / Province / RegionPostal CodePreviousNextEmergency Contact DetailsIf we are unable to reach any of the listed caregivers, please provide an additional contact which could be used in case of an emergency.LayoutName *Day time phone *Relationship to the student *Mobile *Please note, students can only be collected from school by caregivers or emergency contact. If someone else is to collect your child, contact must be made to the school office first to advise who will be collecting the student.PreviousNextMedical DetailsLayoutName of Doctor/Medical Centre *Dentist/Dental Centre *Phone *Phone *Medical History/Health ConcernsPlease tick if your child has had any of the following medical conditions: *ADHDAsthmaDepressionDiabetesEczemaEpilepsyHay FeverHearing ImpairedHeart ConditionLearning DisordersMigrainesVisually ImpairedOtherIf you have ticked any of these conditions, please give us more information below. (e.g. Asthma - severity /frequency, medication, hospital admissions/visits and care plan) Are there any further issues or concerns we should be aware of? *(e.g. anxiety, separation, bereavement or learning difficulties) AllergiesPlease tick if your child has any of the following allergies: *Prescription MedicationFood (eg. Nuts, eggs)Insect BitesDietary RequirementsOtherMy child does not have any allergiesPlease list prescription medication allergies and note if reaction is mild, moderate, or severe(anaphylactic) *Please list food (e.g. Nuts, eggs) allergies and note if reaction is mild, moderate, or severe(anaphylactic) *Please list insect bite allergies and note if reaction is mild, moderate, or severe(anaphylactic) *Please list all dietary requirements *Please list other allergies and note if reaction is mild, moderate, or severe(anaphylactic) *Please list treatment required for allergies *( e.g. requires adrenalin, call ambulance, Phenergan, Ice Pack)In Case of Illness, Accident or EmergencyDo you give permission for First Aid Staff to administer Paracetamol/ Ibuprofen for pain relief? *YesNoIn the event of Illness, accident or emergency whereby staff are unable to contact caregivers, I authorise the school to take action, on my behalf for the medical treatment of my child and agree to meet any costs incurred. This includes incidents at school and off-site where applicable. *YesNoVaccinationsLayoutHas your child been fully immunised? *YesNoIf immunised, please provide photocopied evidence. *Public Health NurseA Public Health Nurse is available once a week to provide for any youth health needs. You have a right to request your child does not attend this clinic. We require a letter to this effect. A nH return will be taken as approval to use the health service.PreviousNextPrivacy StatementThe School manages all personal information it collects from students in accordance with the provisions of the Education Act 1989 and the Privacy Act 1993. The School collects the information on this form o enrol your child at school, to assess the educational needs of your child and ensure the school get the correct resources from the Ministry of Education for your child. It is also used for associated school activities. The information collected may be disclosed to appropriate education, health and welfare authorities and for data gathering purposes by the Ministry of Education, in accordance to the principals of the Privacy Act. It will not be disclosed to any other person or agency unless such disclosure is authorised or required by law. You can request to see the information the school holds on your child and request corrections to the information at any time, by contacting the school. You also have an obligation to advise the school ff or when any personal information you have provided changes.Youth Service The Ministry of Education shares specific personal information witth the Ministry of Social Development (MSD) to support the Youth Service Initiative. The Youth Service identifies young persons who may have difficulty finding future employment, training or further education. The Ministry provides MSD with address and phone number information. The Youth Service uses this information to contact the individuals and support them into employment, training or further education when they leave school. Publication and Display of Student Images and their Work From time to time the school takes photographs of students to record activities within the school for students' learning jopurnals, the schools newsletters, website and marketing material for the purpose of celebrating individual, group or school achievment. It is the school's policy that any photos for publication are positive depictions of the student and/or their work.I give permission for my child's name and/or photograph and/or their work to appear in school publications. *YesNoPreviousNextUpload Documents Please upload a copy of the following documents with this form:LayoutStudent’s birth certificate or passportFile Upload *LayoutStudent’s most recent school reportFile Upload *LayoutStudent’s resident permit/visa (if born outside New Zealand)File Upload *LayoutAdditional Documents Upload up to 3 additional documentsFile UploadFile UploadFile UploadPreviousMessageSUBMIT ENROLMENT