He manu whai huruhuru KAIKORAI VALLEY COLLEGE Opportunity and Success for All APPLICATION FOR ENROLMENT PERSONAL INFORMATION Student Name: ________________________________________ __________________________________________________ (Family name) (Given name – underline name used) Date of birth: __________________________________________ Male Female (Day/Month/Year) Present school: ________________________________________ Present year level or class: ____________________________ CONTACTS Name and address of parents, caregivers and/or legal Caregivers (please indicate who the student lives with): Name: _______________________________________________ Name: ____________________________________________ Address: _______________________________________________ Address: ____________________________________________ _______________________________________________ ____________________________________________ _______________________________________________ ____________________________________________ Post Code: __________________ Lives with: Post Code: ___________________ Lives with: Phone: (home) _________________ (work) ___________________ Phone: (home) _______________ (work) ____________________ Mobile: ________________________________________________ Mobile: _____________________________________________ Email: _________________________________________________ Email: _______________________________________________ Relationship to Student: ___________________________________ Relationship to Student: _________________________________ Current occupation: __________________________________ Current occupation: _____________________________________ Place of work: ________________________________________ Place of work: __________________________________________ Do you require a school report copy (if not living with)? Do you require a school report copy (if not living with)? May the school contact you by text? May the school contact you by text? Please indicate if you wish to receive an electronic Please indicate if you wish to receive an electronic copy of the school’s newsletter copy of the school’s newsletter (if you have selected this option, please check you have supplied your email address) Please list name(s) and addresses of other persons (eg grandparents, close relatives) who could be contacted in case of an emergency or other special need: Name: ______________________________________________ Name: ____________________________________________ Address: ______________________________________________ Address: ____________________________________________ Phone: (home) __________________ (work) ________________ Phone: (home) ________________ (work) __________________ Mobile: ______________________________________________ Mobile: ___________________________________________ Relationship to Student: _________________________________ Relationship to Student: _________________________________ Name(s) of brothers or sisters who are current students: Name: ______________________________________________ Year of entry: __________________________________________ Name: ______________________________________________ Year of entry: __________________________________________ Student’s position in the family (eg 2 of 3): ______________________________________________________________________________ Page 1 of 19 He manu whai huruhuru KAIKORAI VALLEY COLLEGE Opportunity and Success for All MEDICAL Doctor: _______________________________________________ Telephone: ____________________________________________ Medical problems (if any) need to be noted: _____________________________________________________________________________ _________________________________________________________________________________________________________________ Please indicate mediation taken:_______________________________________________________________________________________ If any medication is to be held at school and administered by staff, please indicate you have completed the Administration of Medication form ETHNIC ORIGIN Was your child born in New Zealand or overseas? _________________________________________________________________________ A copy of your child’s birth certificate should be provided for New Zealand citizens if possible and must be provided for those born overseas. Some proof of residency must also accompany the application. Statistical information for Ministry of Education: Ethnic Origin (please tick appropriate ethnic origins of student). NZ/European Māori Chinese Cook Island Fijian Other (name) _______________________________________ Indian Niuean Samoan Tokelauan Tongan (NB: You may tick more than one) If English is not the first language spoken at home, please indicate which is: ____________________________________________ If you are Māori and your iwi is known, please state iwi: (1). ____________________________________________ (2). ____________________________________________ FURTHER INFORMATION Any other important information you would like the school to know: (eg custodial issues) _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ I understand that this information will be kept securely and is being collected to allow Kaikorai Valley College to carry out the functions required of it, and that this information may be disclosed to another specified agency only in accordance with Principles 10 and 11 of the Privacy Act 1993. If this application is accepted, the parent/caregiver and student agree to accept the school’s requirements concerning discipline, attendance, uniform and fees. Email: Please note that your email address is your access to the Parent Portal in EDGE, our Student Management System. Use of Student Photos, Video Clips, work produced and Other Related Material Used for Promotional Purposes: I understand and agree that photographs, video clips, work produced and other related material may be used from time to time in school publications and for promotional and educational purposes. Payment of Course Costs: The payment of costs associated with running courses is important for the ongoing progress of our students. These may be paid upon invoice or by regular automatic payment into the school bank account. Please contact the Student Office if you wish to set up an automatic payment. If you are paying by Internet banking please include your child’s name in the reference line. Parents/caregivers are asked to pay a voluntary donation towards general school activities but this donation is not mandatory. There will be additional costs for specific school events/activities, which will be advised prior to the event/activity. By signing this form, I am demonstrating that I am willing to pay costs associated with my child’s education. Contact Details on this form are required by law to be forwarded to the Ministry of Social Development. This is so at risk young people can be identified and offered support by organisations contracted to help re-engage young people in education or training when they leave school. The information will not be used for any other purpose. Disclaimer: The Kaikorai Valley College Board of Trustees makes every effort to ensure the grounds and buildings of the college are a safe environment. The Board however accepts no responsibility for any accident or injury that may be sustained by any person or persons, or for damage or loss to property, while on these premises. Signed: Student: __________________________________________________ Signed: Parent/Caregiver: __________________________________________________ Date: _________________________ This form should be completed and forwarded, along with the Cybersafety Use and Cellphone and Digital Music Player agreements, Transport and EOTC agreements, and a certified copy of your child’s birth certificate to the Main Office, Kaikorai Valley College, 500 Kaikorai Valley Road Bradford, Dunedin 9011 Page 2 of 19 He manu whai huruhuru KAIKORAI VALLEY COLLEGE Opportunity and Success for All ADMINISTRATION OF MEDICATION If your child is having medication administered during the school day we ask that you sign and return the slip below to the school office as soon as possible. Without this signed form the school will not administer medication. The staff at the school are willing to administer medication to your child subject to the following conditions: 1. That the medication is provided to the school office, or to staff on out-of-school activities by the parent/caregiver of the child – this must be in a named container or envelope; 2. That written instructions are provided to the school office, or to staff on out-of-school activities, regarding how the medication is to be administered in advance of the administration of medication. 3. That the staff of the school will take all reasonable steps to ensure that the medication is administered in accordance with the instructions, but it will not be held responsible for: . any long-term or side effects of the medication; . not administering the medication on any particular occasion; . students not taking their medication in accordance with instructions. Please sign the statement below if you accept the above conditions. Yours sincerely On behalf of the Board of Trustees Rick Geerlofs Principal I accept the above conditions relating to the administering of medication to my child at school by school staff. Student’s name: ____________________________________________________________________________