Student Information

Student lives with:

Parents Mother Father Caregiver Other

Gender Male Female

Ethnicity

NZ European NZ Maori Other

Residency Yes No

Will you travel to school by country bus? No Yes

Primary Caregiver

Title Mrs Ms Miss Mr

Secondary Caregiver

Emergency Contact Person

Relation to Student Relative Neighbour Friend

Medical Information

Panadol Please Select Yes No

If yes 1 or 2 Please Select 1 2

Ibuprofen Please Select Yes No

If yes 1 or 2 Please Select 1 2

Enrolment Declaration

I undertake to comply with the school regulations as set out in the prospectus, together with any further regulations as decided and advertised by the school board of trustees. Other contributions are to cover costs over and above the basic requirements t Please Select Yes I agree No I do not agree

I acknowledge and accept all enrolment declarations, rules and terms

No Yes

I acknowledge and accept all enrolment declarations, rules and terms

No Yes