Application for Enrolment

SECTION 1: STUDENT DETAILS

Family Name*
Given Names*
Preferred Name: (if different to given name):
Date of Birth:*
Hostel:*
Home Address:*
Student Mobile:*
-
Last School Attended:*
Date last attended:*
Level enrolling for:*
Ethnic Group(s)( List in priority order):*
Maori Iwi Affiliation (if applicable):*
Siblings presently at Wairarapa College:*

SECTION 2: PRIMARY RESIDENCE

Caregiver 1: Title*
Family Name:
Given Name:
Relationship to Student:
Address (residential):
Is their postal address the same?*
Postal Address:
Phone (home):
-
Phone (work):
-
Mobile phone:
-
E-mail:*
Occupation:
Work Place:
Do you have another Caregiver?*
Caregiver 2: Title*
Family Name (Caregiver 2):
Given Name (Caregiver 2):
Relationship to Student (Caregiver 2):
Address (residential - Caregiver 2):
Is Caregiver 2s postal address the same?*
Postal Address (Caregiver 2):
Phone (home - Caregiver 2):
-
Phone (work - Caregiver 2):
-
Mobile phone (Caregiver 2):
-
E-mail (Caregiver 2):*
Work Place (Caregiver 2):
Occupation (Caregiver 2):

SECTION 3: SECONDARY RESIDENCE

Do you have a Secondary Residence:
Caregiver 1 (Secondary Residence): Title*
Family Name (Caregiver 1 Secondary Residence):
Given Name (Caregiver 1 Secondary Residence):
Relationship to Student (Caregiver 1 Secondary Residence):
Address (Caregiver 1 Secondary Residence):
Phone (home - Caregiver 1 Secondary Residence):
-
Phone (work - (Caregiver 1 Secondary Residence):
-
Mobile phone (Caregiver 1 Secondary Residence):
-
E-mail (Caregiver 1 Secondary Residence):*
Occupation (Caregiver 1 Secondary Residence):
Work Place (Caregiver 1 Secondary Residence):
Do you have another Caregiver at your Secondary Residence:
Caregiver 2 (Secondary Residence): Title*
Family Name (Caregiver 2 Secondary Residence):
Given Name (Caregiver 2 Secondary Residence):
Relationship to Student (Caregiver 2 Secondary Residence):
Address (Caregiver 2 Secondary Residence):
Phone (home - Caregiver 2 Secondary Residence):
-
Phone (work - (Caregiver 2 Secondary Residence):
-
Mobile phone (Caregiver 2 Secondary Residence):
-
E-mail (Caregiver 2 Secondary Residence):*
Occupation (Caregiver 2 Secondary Residence):
Work Place (Caregiver 2 Secondary Residence):

SECTION 4: EMERGENCY CONTACT

(other than parent/caregiver)

Title (Emergency Contact):
Family Name (Emergency Contact):
Given Name (Emergency Contact):
Relationship to Student (Emergency Contact):
Address (Emergency Contact):
Phone (home - Emergency Contact):
-
Phone (work - Emergency Contact):
-
Mobile phone (Emergency Contact):
-

SECTION 5: MEDICAL

(All information provided is confidential)

Medications:
Allergies/Reactions:
Doctor’s Name:
Phone - Doctor:
-
Dentist’s Name:
Phone - Dentist:
-
Any other medical conditions:
I give permission for Panadol to be given for pain relief:

SECTION 6: ADDITIONAL INFORMATION


Where to send correspondence/reports:
Where to send accounts:
First Time enrolling at a New Zealand School:
Date of NZ Entry:*

You will be asked to bring supporting documentation to your interview.