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ENROLMENT FORM 2011

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					           KAITAO MIDDLE SCHOOL ENROLMENT FORM                                                                                        -      2011

F A M I L Y N A M E O F C H I L D : ________________________________________________                                      FOR OFFICE USE ONLY
                                          (As shown on Birth Certificate)

F I R S T N A M E S O F C H I L D : ________________________________________________                                    YEAR: ______        ROOM: ______
                                          (As shown on Birth Certificate)
                                                                                                                        ACADEMY: _________________
P R E F E R R E D F I R S T N A M E : ________________________________________________
                                                                                                                        HOUSE: __________________
SCHOOL LAST ATTENDED:                 _____________________________________________
                                                                                                                        DATE STARTED: _____________
DATE OF BIRTH:                    ___ /___ /_______
                                                                                                                        ENTERED:
Y E A R /G E N D E R              YEAR 7                YEAR 8                  BOY          GIRL     
                                                                                                                        ADMISSION NO:      _____________
ADDRESS OF STUDENT:                _________________________________________________
                                    _________________________________________________                                   PREV. ADMISS. NO: ____________
HOME TELEPHONE NO:                 _________________________________________________

CAREGIVER’S MOBILE NO: ____________________________                             EMAIL ADDRESS: ________________________________________


N A M E O F P A R E N T S /G U A R D I A N S WIT H WHOM CHILD LIVES:

N A M E O F M O T H E R /G U A R D I A N : _____________________________________                     (Mrs/Miss/Ms)     ______________________________
                                                              Surname                                                                     First Name

                       Work Phone: ________________________________                                          Occupation:       ________________________

                       Additional Mobile: ____________________________                       Relationship to Student: _______________________
                                                                                                                                 (Mum, Dad, Aunt, Caregiver etc…)



N A M E O F F A T H E R /G U A R D I A N : _____________________________________                                               ________________________
                                                              Surname                                                                First Name

                       Work Phone: ________________________________                                          Occupation:       ________________________

                       Additional Mobile: ____________________________                       Relationship to Student: _______________________
                                                                                                                                 (Mum,    Dad,   Aunt,   Caregiver   etc…)

O T H E R P A R E N T S (if not living at above address and have access to the child):

           Name:       ________________________________________ (Mr/Mrs/Miss/Ms)                      Phone:         _________________________
           Address:                ________________________________________                               Mobile: _________________________
           Relationship to Student:        __________________________________

Other Emergency Contact (in Rotorua):                        Name: (Mr/Mrs/Miss/Ms)                                         Phone: ___________________
                                                             Relationship to Student:   _____________________           Mobile: ___________________


N A T I O N A L I T Y O F C H I L D (Country of Birth): NZ                       O T H E R : (please specify): ___________________________
CHILD’S CURRENT CITIZENSHIP:                             NZ                      O T H E R : (please specify): _________________________________
ETHNIC GROUP:
Please tick  the box or boxes next to the ethnic group or groups you feel your child belongs to:

 Maori:        Iwi:            Te Arawa                        Tuhoe                    Tainui                       Other  _______________________
                 Hapu:          Ngati Whakaue                  Te Urewera              Ngati Tamatera             Other  _______________________

 NZ European               Pacific Islands (Specify) __________________________                     Asian (Specify) _______________________
                Other                     (Specify)   __________________________
What is the Main Language Spoken at Home? ________________________________________________________
                                                                                                                                                          Please turn over
                                                                                                                                   Page 2

S PECIAL C IRCUMSTANCES /S ENSITIVE I NFORMATION (Additional information which may assist the school – eg: Custody Issues)
____________________________________________________________________________________________________
____________________________________________________________________________________________________


                                                               A CADEMY C HOICE : (P LEASE CHECK P ROSPECTUS FOR MORE DETAIL )
    F IRST                                        Challenge                                                                                               Sport and Fitness
   C HOICE
                                                  Expressive                                                                                              Arts and Performance
                                                  Discovery                                                                                               ICT Digital Classrooms
                                                  *Accelerate                                                                                             Highly Academic
                                                  *Adventure Learning                                                                                     Literacy/Numeracy Skills Focus
                                                  Rumaki                                                                                                  Te Reo Maori Immersion
                                                  Bilingual                                                                                               Te Reo Maori Bilingual

S ECOND C HOICE                                   Challenge                                                                                               Sport and Fitness
                                                  Expressive                                                                                              Arts and Performance
                                                  Discovery                                                                                               ICT Digital Classrooms
                                                  *Accelerate                                                                                             Highly Academic
                                                  *Adventure Learning                                                                                     Literacy/Numeracy Skills Focus
                                                  Rumaki                                                                                                  Te Reo Maori Immersion
                                                  Bilingual                                                                                               Te Reo Maori Bilingual


A CCELERATE T EST :                             Yes                       No                                                                                                       A DVENTURE T EST : Yes                                             No   
                                                      I would like to meet with Claire Schnell to discuss the academies further                                                                                           
______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________



                                                               PARENT/CAREGIVER DECLARATION
I/WE acknowledge that the information completed is true and correct in every particular and will be relied upon by the
school.

I/WE agree that our child shall abide by all School Rules and Regulations, especially regarding uniform.

I/WE understand the need to pay fees related to curriculum activities – ie: Technology.

I/WE understand that the information on this form will be used by Kaitao Middle School to maintain appropriate
school records and effective contact with the enrolled pupil's parents/caregivers.

I/We also agree to the school:
* Requesting relevant information from other schools for enrolment purposes and class placements.
* Forwarding relevant information to another school for enrolment purposes and class placements.
           COPY OF BIRTH CERTIFICATE OR PASSPORT ATTACHED : THIS IS A MINISTRY REQUIREMENT!
           PROOF OF NZ CITIZENSHIP ATTACHED IF BORN OUT OF NZ : THIS IS A MINISTRY REQUIREMENT!

Signature: ____________________________                                                                                                                                                      Date:
                                        (Parent/Caregiver)

				
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Description: ENROLMENT FORM 2011