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Student Enrolment Form

Family Declaration: I / We give permission for my child to be treated by the school designated First Aider or school staff member. Yes No (tick one)

MORRINSVILLE INTERMEDIATE SCHOOL
24 Elizabeth Avenue, Morrinsville 3300 Phone: 07 889 6629 FAX: 07 889 5645 Email: office@mi.school.nz

WEBSITE: http://morrinsvilleint.ultranet.school.nz

Student Enrolment Form
Student Information :

I wish to make application for my child to enroll at Morrinsville Intermediate School. I understand the conditions in the prospectus and agree to abide by them. In particular I / We agree that:  The school uniform will be worn fully and correctly  The school behaviour code will be adhered to  The policies of the school, additional to the prospectus, will be supported.  I / We undertake to ensure that my child will attend school regularly  I / We will take responsibility for the payment for repairs to damage to school property that our son/daughter causes Mother / Guardian Signature
or

Family Name First Name(S) Preferred Name Address Year 7

Previous School Date Of Birth 8 Gender Boy Girl

Father / Guardian Signature Date

Family Information:
Mother / Caregiver’s Name Home Address (if different from above)

Computer and Internet Acceptable Use Agreement

Contact Details Phone: Home Mobile Occupation Place of Work Father / Caregiver’s Name Home Address (if different from above) Work Email

Student:

I understand and will abide by the conditions and terms set out in the

Parent / Caregiver

Computer and Internet Acceptable Use Agreement.
I further understand that there will be consequences (including loss of ICT privileges in the school) if I should violate these conditions

I have read and understood the Computer and Internet Acceptable Use Agreement . I know that the ICT resource, including the internet is available for educational purposes. I recognise that it is impossible for the school to fully restrict access to controversial material. I realise that it is ultimately the responsibility of each student to use the resource responsibly for school related work only. I give permission for my child to be allowed internet access.

Signature of Student

Signature of Parent / Guardian

Contact Details Mobile

Phone: Home Email Work Place

Work

School Use Only Enrolled By Date of Admission Enrolment Number Room No. /Year
/ Birth Certificate Sighted Passport/ Visa Status

Occupation Emergency Contact Relationship to Child

Phone:

Student Enrolment Form
Statistical and Enrolment Data Ethnic Group: (please tick) NZ Maori Samoan Niuean Other Iwi Affiliations What is the main language spoken at home? Students Born Outside New Zealand Must Complete the Following:
Please Note: For all students not born in New Zealand, their original documentation (Passport/Visa) must be presented to the school office with the enrolment form. The enrolment cannot be accepted until the documentation is shown.

Student Enrolment Form
Class Placement Information
Information you can share to help your child to make a smooth transition into our school. Please comment where appropriate.

European Indian Tongan

Cook Island Maori Chinese South African
(please Specify)

Learning Strengths

Learning Support Needed (Learning Difficulties)

Please comment if your child receives Special Education Support

Does your child require support with English as a new language?

YES / NO

Country of Birth Status ~ please tick one

Date of Entry to NZ

Information Privacy NZ Citizen Visitor Passport Number NZ Resident Refugee Student Visa/permit Visa Expiry Date
I agree to Morrinsville Intermediate School collecting personal information and obtaining records from the previous school on:

Name:
I understand that the information I provide will be used to assist with the provision of an education for this person. This information may be shared with Health, and other education agencies, if they are involved, to further assist the learner. I accept that this information may later be used for statistical and/or research purposes and agree to its use for that purpose, provided that if the information is published in any way it will not identify me or the individual concerned. I understand that the information I provide will be held at Morrinsville Intermediate School whose address is: Morrinsville Intermediate School 24 Elizabeth Avenue MORRINSVILLE Telephone: 07 889 6629 Fax: 07 889 5645 Email: office@mi.school.nz This information may be transferred to another school if the child moves I am aware of the rights of access to, and correction of this information I also give permission for my child to be included in photographs taken while involved in school activities, and ~ I give permission for my child’s work and photograph (unnamed) to appear on the school’s website.

Health, Medical & Personal Name of Doctor Medical Problems: Phone
ASTHMA EPILEPSY HEART ALLERGIES DIABETES HEPATITIS B

Other Medical Problems:

Severity

Mild

Moderate Yes

Severe No

Signed:
(Individual / Parent / Legal Guardian / Agent)

Date

Medication to be held at school

Does anyone NOT have access to the child