Online Enrolment

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Student Details
Student's Name*
First Last
Student's Preferred Name
First Last
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Other
If "Other", please specify*
Current Year Level

Optional
Other siblings at this School*
- Yes
- No
Previous School
Address*
Street Address Address Line 2 City Suburb Post Code
In Zone*
- Yes
- No
Ethnicity
Iwi/Hapu
Affiliation
Ethnic Group/s*
Language child uses when speaking to Mother*
Can Mother speak English?*
- Not at all
- A little
- Fluently
Can Mother read English?*
- Not at all
- A little
- Fluently
Language child uses when speaking to Father*
Can Father speak English?*
- Not at all
- A little
- Fluently
Can Father read English?*
- Not at all
- A little
- Fluently
Country of Birth*
Country
Nationality*
Country
Residency Status*
- NZ Citizen
- NZ Permanent Resident
- Domestic Student Visa
- Other Visa
Visa No.*
NZ Entry Date*
DD slash MM slash YYYY
Expiry Date*
DD slash MM slash YYYY
Parent/Caregiver Details (1)
Name*
Prefix First Last
Country of Birth*
Country
Residency Status*
Ethnicity or Iwi*
Primary Caregiver*
- Yes
- No
Relationship to Student*
Address*
Same as Student Home Address

Street Address Address Line 2 City Suburb Post Code
Occupation*
Work Place
Email*
Home Phone
Work Phone
Mobile Phone*
Parent/Caregiver Details (2)
Name
Prefix First Last
Country of Birth*
Country
Residency Status*
Ethnicity or Iwi*
Primary Caregiver
- Yes
- No
Relationship to Student
Address
Same as Student Home Address

Street Address Address Line 2 City Suburb Post Code
Occupation
Work Place
Email
Home Phone
Work Phone
Mobile Phone
Emergency Contact (1)
Name*
Prefix First Last
Relationship to Student*
Home Phone
Work Phone
Mobile Phone*
Emergency Contact (2)
Name*
Prefix First Last
Relationship to Student*
Home Phone
Work Phone
Mobile Phone*
Health
Known medical conditions
Medication held at School? (if YES, complete Medication Administration Form)
- Yes
- No
Severity
- Low Risk
- Moderate Risk
- Contact Caregiver(s)
I give permission for the Public Health Nurse to attend to my child when necessary*
- Yes
- No
Immunisation*
- Fully immunised to 15 months
- Fully immunised to 4 years
- Not fully immunised
Medical Center Name*
Doctor's Name*
Doctor's Phone*
Has your child received any learning support in the past*
(tick all that apply):
- ORS
- RTLB
- MOE
- SLS
- Teacher Aide
Has your child had any assessment for the following*
(tick all that apply):
- ADD/ADHD
- Asperger’s
- Autism
- Dyslexia
- Other
Other, please specify*
Sight (Glasses)*
- Yes
- No
Hearing Aid*
- Yes
- No
Other Assistive Technology*
- Yes
- No
Other Assistive Technology, please specify*
Custody/Access Arrangements
Student lives with*
- Both Parents
- Shared Custody
- Mother
- Father
- Guardian
Court Order Issued*
- Yes
- No
Court Order Documents
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Access Arrangement
Early Childhood Education
Prior-Participation in Early Childhood Education
Please select (up to 3 services) for the last Early Childhood Education service(s) attended in the six months prior to starting school
- Kohanga Reo
- Play Center
- Kindergarten or Educations and Care Centre
- Home based service
- Playgroup
- The Correspondence School - Te Aho Te Kura Pounamu
Hours per Week at Kohanga Reo*
Hours per Week at Play Center*
Hours per Week at Kindergarten or Educations and Care Centre*
Hours per Week at Home based service*
Hours per Week at Playgroup*
Hours per Week at The Correspondence School - Te Aho Te Kura Pounamu*
Documents
Proof of in zone address*
Council rates, water care, electricity bill etc.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Birth Certificate/Passport*
If student is a New Zealand citizen
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Passport*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Parent's Passport*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Parent's Visa*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Immunisation Documents*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Health Form*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Additional Fields
I would like my child to participate in the Fruits in Schools programme*
- Yes
- No
I would like my child to participate in the KidsCan programme*
- Yes
- No
I would like my child to receive the MoE free Healthy School Lunches Programme*
- Yes
- No
Please specify any special dietary requirements/food allergies
Digital Technology & Online Safety
Please check the box to indicate your agreement
- Select All
- I have read the Student Device ‘Kawa of Care’ Agreement and understand that my child is responsible for using School allocated devices and access the Internet for learning purposes only and as directed by the teacher. I have discussed this Agreement with my child, explained its importance and the consequences for breaking this Agreement.
- I understand that the School takes steps to minimise and remove access to any material which could be harmful or illegal for the student. It is my child’s responsibility not to have any involvement with or access harmful and illegal sites and material.
- I understand that NO cell phones are allowed at School.
- I give permission for my child to access the Internet and their student email for learning purposes only.
EDUCATION OUTSIDE THE CLASSROOM (EOTC e.g., school related trips, events, activities are part of the Curriculum. We send home notices and sometimes ask for volunteer help. We ask for a contribution towards any Camps)
I give permission for my child to attend EOTC trips and activities necessary for their learning. I understand that I may withdraw my permission at any time.*
- Yes
- No
Privacy & Permissions
- The information collected about your child will be used by the School for enrolment, placement, and organisation.
- The records made from this information may be viewed on request at the School only with your permission.
- The information collected may be disclosed to appropriate education, health and welfare authorities, and for data gathering purposes by the New Zealand Ministry of Education, in accordance with the December 2020 Privacy Act. It will not be disclosed to any other person or agency unless such disclosure is authorised by the legal parent / guardian / caregiver or required by law.
I agree and give permission for my child’s School work, image or video to be published for School, and learning purposes:*
(check the box to indicate your agreement)
- Newsletter
- School Website
- School Facebook page
- Class Site
Parent/Caregiver Agreement
Please check the box to indicate your agreement*
- Select All
- I agree to send my child to School every day (unless sick), be on time, and wearing compulsory School uniform.
- If my child is absent, I will call/inform the Office before 8:55 am at the latest giving the reason for absence.
- I agree to abide by all Viscount School policies and procedures (refer our ‘SchoolDocs’ on our School Website).
- I confirm that the information given on this form is true and correct in every particular.
By signing this below, I confirm that the information given in this form is true, complete and accurate.
Full Name*
Relationship to Student*
Home Phone
Mobile Phone*
Work Phone
Date*
DD slash MM slash YYYY
CAPTCHA
Comments
This field is for validation purposes and should be left unchanged.

Student Details

Ethnicity

Parent/Caregiver Details (1)

Parent/Caregiver Details (2)

Emergency Contact (1)

Emergency Contact (2)

Health

Custody/Access Arrangements

Early Childhood Education

Documents

Additional Fields

Digital Technology & Online Safety

EDUCATION OUTSIDE THE CLASSROOM (EOTC e.g., school related trips, events, activities are part of the Curriculum. We send home notices and sometimes ask for volunteer help. We ask for a contribution towards any Camps)

Privacy & Permissions

Parent/Caregiver Agreement

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Term Dates 2025