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Please fill in the following information and take note of required fields
Today's date
(Required)
STUDENT'S DETAILS
Name
(Required)
First
Last
Preferred name
Gender
Birth date
(Required)
Nationality
(Required)
Main language spoken at home
(Required)
If Maori, please state Iwi
Was the student born in NZ
(Required)
Yes
No
Country of birth
(Required)
Immigration status
(Required)
NZ Citizen
Permanent NZ Resident
Work Permit
Student Permit
Other
Date arrived in NZ
(Required)
Expiry of permit
(Required)
STUDENT'S ADDRESS DETAILS
Home address
(Required)
Street address
Suburb
City
Post code
Home phone
(Required)
Parent/s email
(Required)
FAMILY INFORMATION
Mother / Guardian / Caregiver
Title
Mrs
Miss
Ms
Name
(Required)
First
Last
Work phone
(Required)
Mobile phone
(Required)
Occupation
(Required)
Address (if different from above)
Street address
Suburb
City
Post code
Father / Guardian / Caregiver
Name
(Required)
First
Last
Work phone
(Required)
Mobile phone
(Required)
Occupation
(Required)
Address (if different from above)
Street address
Suburb
City
Post code
Emergency contact (not at same address)
Name
(Required)
First
Last
Best contact number
(Required)
Relationship to student
(Required)
Address
(Required)
Street address
Suburb
City
Post code
OFFICE INFORMATION (to be filled in by office staff only)
Start date
Tutor group
NSN #
House
Year level
PREVIOUS SCHOOL INFORMATION
Previous school
(Required)
Length of attendance
(Required)
Date started
(Required)
Date left
(Required)
Has your child ever been stood-down and/or excluded, or roll-removed from a previous school?
(Required)
Yes
No
Please state why
(Required)
Other family members at Bader Intermediate
EXTRA LEARNING SUPPORT
Has your child had extra support, e.g. ESOL (English as a second language), SWSN (Student with Special Needs, SWSA (Student with Special Abilities, RTLB, Teacher Aide or Speech Therapy?
(Required)
Yes
No
Please list details
(Required)
Other information offered by parent/s: Including custody, access arrangements and/or court orders
If the child you are enrolling is not your biological child, you must provide evidence you are the child’s legal guardian
File
Max. file size: 2 MB.
OFFICE INFORMATION (to be filled in by office staff only)
Legal documentation photocopied
Yes
No
SLT advised
Yes
No
HOBBIES / SPORTS / SPECIAL INTERESTS
Sports your child likes to play
Ever played sports for any Rep Teams?
Yes
No
Please state what Rep Teams
Can your child play any musical instruments?
Yes
No
Please state what musical instruments
Does your child have a musical background?
*HEALTH FORM MUST BE COMPLETED IN FULL
*Before your child can start school here, you must provide a full immunisation certificate from your GP or your Community Healthcare Clinic – your child will not be able to start without this
Student's name
(Required)
First
Last
Year Level
(Required)
Family doctor
(Required)
Phone
(Required)
Dentist
(Required)
Phone
(Required)
Please select the following correct checkbox/es if your child has or has had the following disabilities, allergies or medical problems which may affect their performance or activities at school
Please note, we can no longer administer over the counter medications such as panadol / paracetamol to your child
Medical condition
Asthma
Diabetes
Epilepsy
Rheumatic Fever
Hepatitis A or B / HIV
Glandular Fever
Frequent headaches
Migraines
Sinus
Hay Fever
Heart conditions
Tuberculosis
Nose bleeds
Recurring abdominal pain
Back / Neck problems
Past illness or operations
Other
Allergies
Bee stings
Medication
Food
Other
Allergic reaction to
Medication required
(Required)
Yes
No
List of medication required
(Required)
Please send labelled medication to the school if it is required for regular use or for emergencies (i.e.: antihistamines for bee stings)
Does your child have on a regular basis
Any medication not mentioned above?
A course of treatment / counselling?
If yes, please detail
(Required)
If yes, please detail
(Required)
Sensory loss
Yes
No
If yes, please select relevant checkbox/es
Visual or hearing affected
(Required)
Visual
Hearing
Problem area
(Required)
Right
Left
Bilateral
Amount of vision or hearing affected
(Required)
Mild
Medium
Severe
100% total loss
Devices used
(Required)
Other relevant conditions
e.g. cardiac murmur, limited PE, Cystic Fibrosis, etc.
Other relevant conditions
(Required)
Yes
No
If yes please detail
(Required)
Special home circumstances
Are there any factors that may affect the student’s behaviour or emotional stability?
(Required)
Yes
No
If yes please detail
(Required)
Asthma suffers only to fill in
Does the student have an “Asthma Action Plan”?
*Yes
No
*If YES, please give a copy to the School Nurse. If using preventers, the Asthmas Society recommends having an Action Plan (which requires updating every 6–12 months). See your GP / Practice Nurse. In case of a serious accident or emergency, an ambulance will be called. A parent/guardian will also be called, so please ensure that the School has your most current contact details.
Consent to the statement below
Consent
(Required)
I agree
The School realises that family circumstances and a student’s health may change in the course of a year. It would be very much appreciated if the School is notified as soon as possible by either:
• A phone call to the School Office on 09 275 4332
• A note sent into the School Office
• A note sent to your child’s teacher.
Note: This information is for School purposes. The School reserves the right to pass on this information to other agencies if it sees fit to hold and store the information.
Student name
(Required)
First
Last
Year level
Room
ATTENDANCE / EOTC ACTIVITIES / CYBER SAFETY & INTERNET USE / PUBLICATION OF IMAGES
STUDENT RESPONSIBILITIES
Consent of student
(Required)
I, the student, have read the Cybersafety Use Agreement statement below and am aware of the school’s initiative to maintain a cybersafe learning environment, including the responsibilities involved
I undertake that my child attends school regularly, wears correct school uniform, follows the school rules and regulations as set by the SDBI Board of Trustees. I also give permission
for the information contained in this enrolment form and student’s attainment records, to be made available to other educational and support agencies.
Occasionally students are asked to attend school trips, sports exchanges and events outside of school. I give permission for my child to attend these activities throughout the year.
We understand that Sir Douglas Bader Intermediate will;
• Do its best to keep the school cybersafe, by maintaining an effective cybersafety programme. This includes
working to restrict access to inappropriate, harmful or illegal material on the Internet or the school ICT equipment / devices at school or at school related activities, and enforcing the cybersafety regulations and responsibilities detailed in use agreements
• Keep a copy of this signed use agreement on web form on file (by ticking the consent box for both Student and Parent / Legal Guardian / Caregiver, you are hereby signing this form
• Respond appropriately to any breaches of the use agreements
• Provide members of the school community with cybersafety education designed to complement and support the agreement initiative
• Welcome enquiries from students or parents about cybersafety issues.
We understand that Sir Douglas Bader Intermediate is in no way responsible for;
• Personal digital devices that are broken while at school or during school-related activities
• Personal digital devices that are lost or stolen at school or during school-related activities
Students Responsibilities include:
• I will read the Cybersafety Use Agreement carefully
• I will follow the cybersafety rules and instructions whenever I use the school’s computer network, internet access facilities, computers and other school ICT equipment / devices
• I will also follow the cybersafety rules whenever I am involved with privately-owned ICT devices/equipment on the school site or at any school-related activity, regardless of its location
• I will avoid any involvement with material or activities which could put at risk my own safety, or the privacy, safety or security of the school or other members of the school community
• I will take proper care of school owned ICT equipment/devices. I know that if I have been involved in the damage, loss or theft of ICT equipment/devices, my family may have responsibility for the cost of the repairs
or replacement
• I understand that I must surrender my own personal device to the office before school starts, and collect at the end of the day, otherwise, if it is confiscated, only my parent / caregiver can collect it from the office
• I will not distribute pictures or video of students or staff without their permission (distribution can be as small as emailing / texting to one other person or as large as posting images or video online)
• I have read and understand my responsibilities and agree to abide by this Cybersafety Use agreement. I know that if I breach this use agreement, there may be serious consequences.
Parent / Legal guardian / Caregiver name
(Required)
First
Last
Consent of parent / legal guardian / caregiver
(Required)
I, the parent / legal guardian / caregiver have read the Cybersafety Use Agreement statement below and am aware of the school’s initiative to maintain a cybersafe learning environment, including the responsibilities involved
I undertake that my child attends school regularly, wears correct school uniform, follows the school rules and regulations as set by the SDBI Board of Trustees. I also give permission
for the information contained in this enrolment form and student’s attainment records, to be made available to other educational and support agencies.
Occasionally students are asked to attend school trips, sports exchanges and events outside of school. I give permission for my child to attend these activities throughout the year.
We understand that Sir Douglas Bader Intermediate will;
• Do its best to keep the school cybersafe, by maintaining an effective cybersafety programme. This includes
working to restrict access to inappropriate, harmful or illegal material on the Internet or the school ICT equipment / devices at school or at school related activities, and enforcing the cybersafety regulations and responsibilities detailed in use agreements
• Keep a copy of this signed use agreement on web form on file (by ticking the consent box for both Student and Parent / Legal Guardian / Caregiver, you are hereby signing this form
• Respond appropriately to any breaches of the use agreements
• Provide members of the school community with cybersafety education designed to complement and support the agreement initiative
• Welcome enquiries from students or parents about cybersafety issues.
We understand that Sir Douglas Bader Intermediate is in no way responsible for;
• Personal digital devices that are broken while at school or during school-related activities
• Personal digital devices that are lost or stolen at school or during school-related activities
Students Responsibilities include:
• I will read the Cybersafety Use Agreement carefully
• I will follow the cybersafety rules and instructions whenever I use the school’s computer network, internet access facilities, computers and other school ICT equipment / devices
• I will also follow the cybersafety rules whenever I am involved with privately-owned ICT devices/equipment on the school site or at any school-related activity, regardless of its location
• I will avoid any involvement with material or activities which could put at risk my own safety, or the privacy, safety or security of the school or other members of the school community
• I will take proper care of school owned ICT equipment/devices. I know that if I have been involved in the damage, loss or theft of ICT equipment/devices, my family may have responsibility for the cost of the repairs
or replacement
• I understand that I must surrender my own personal device to the office before school starts, and collect at the end of the day, otherwise, if it is confiscated, only my parent / caregiver can collect it from the office
• I will not distribute pictures or video of students or staff without their permission (distribution can be as small as emailing / texting to one other person or as large as posting images or video online)
• I have read and understand my responsibilities and agree to abide by this Cybersafety Use agreement. I know that if I breach this use agreement, there may be serious consequences.
*KA ORA, KA AKO – Healthy Schools Lunch Programme
*We are pleased to advise our school’s participation in this programme, providing a healthy school lunch to your child every school day. You must complete this form in to advise us of any dietary requirements your child has, as well as any allergies. You must also provide the school with medication for your child should your child have an allergic reaction.
Student name
First
Last
Year level
My child has special dietary requirements
Yes
No
Select what applies
Vegan
Vegetarian
Gluten free
Dairy free
Halal
My child has food allergies
Yes
No
Please list your child's food allergies
(Required)
*Medication taken for your child's food allergies
(Required)
*Please ensure the school is aware of your child’s allergies, and you have given this medicine to the school office for your child in case of emergency
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