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Enrolment Form

Enrolment Form

Home // Enrolment Form

Please fill out the form below and one of our team will be in touch.

STUDENT NAME

Legal Surname

First Names

Year Level:

Year Level 7 Year Level 8

This enrolment is for

2022 2023

Gender

Male Female

Date Of Birth

Previous School

Citizenship

(Please provide a copy of a birth certificate/passport showing current immigration status if required)

Or you can bring this into the school office.

Birth Certificate / Passport

Ethnicity

NZ European Maori Tonga Niuean Samoan Cook Island Asian Other

Other

If Māori please indicate Iwi

Language(s) spoken at home in addition to English:

CLASS PLACEMENT

Do you wish to be considered for one of our Māori Medium Classes?

YES NO

Has your child had previous Kura education?

YES NO

Has your child had previous Bilingual education?

YES NO

PARENT/GUARDIAN

Surname:

First Name

Email address

Relationship to Pupil:

Address:

Home Phone:

Mobile:

Work Place:

Occupation:

Work Phone:

Parent/Caregiver 2

Surname

First Name:

Relationship to Pupil:

Email address

Address:

Home Phone:

Mobile:

Occupation:

Work Place:

Work Phone:

EMERGENCY CONTACT OTHER THAN PARENT/GUARDIAN

Name:

Phone:

Relationship to Student:

Mobile:

MEDICAL INFORMATION

Does your child wear glasses or have eyesight issues?

YES NO

Does your child have hearing problems?

YES NO

Does your child have asthma?

YES NO

Other medical issues

Doctor:

Telephone:

Does your child have any dietary information that we need to be aware of? (This information will be used for the organisation of free school lunches).

BROTHERS / SISTERS AT MONRAD INTERMEDIATE SCHOOL

Name:

Year Attended:

Name:

Year Attended:

Is there any further information regarding the care of this child that the school should know

Consent

I consent to my child being taken out of the school grounds by staff to attend school-related activities within Palmerston North. (I consent to my child travelling in the school van).

I consent for any images of my child or his/her work to be used in any promotion of the school.

I consent for my child’s name to be published in any promotion of the school.

I understand that information may be used by:

- The school as appropriate and as required by protocols between the school and external agencies
- Ministry of Education
- Other agencies where disclosure is required for the maintenance of law and order as defined in Principle 11 of the Privacy Act 1993
-I understand that I have the right to see and correct if necessary the information which I have provided.

Student’s Name:

Date

Parent/Caregiver Name:

Date

Term 1 2022
Tuesday 2nd February – Thursday 14th April

Term 2 2022
Monday 3rd May – Friday 8th July

Term 3 2022
Monday 26th July – Friday 30th September

Term 4 2022
Monday 18th October – Friday 17th December

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Monrad Tirohanga

228 Botanical Road, Palmerston North, New Zealand
office@monrad.school.nz
+64 6 357 9777

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