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Enrolment Type

In Zone Out of Zone

Student's First Name

Student's Second Names

Gender

Male Female Other

Starting Rangeview in

Siblings at Rangeview School

Send Mail to whom (tick all that applies)

Language Spoken at Home

Student Refugee Status/NZ Residency Status

Date of Entry into NZ

Parent/Caregiver Details (1)

Primary Caregiver

Yes No

Relationship to Student

Work Place (Company Name)

Parent/Caregiver Details (2)

Primary Caregiver

Yes No

Relationship to Student

Work Place (Company Name)

Other Custodial Parent/Caregiver

Primary Caregiver

Yes No

Relationship to Student

Work Place (Company Name)

Emergency Contact - Alternative to Caregiver

It is a requirement that you please provide the name of one other person who can be contacted regarding your child. This can be a family member, friend, or work colleague. By nominating this person, you are giving permission for them to pick your child up from school if we cannot reach any of the above listed Caregivers.

Relationship to Student

Health

please eneter NA if not applicable for each box

Special Learning and Behavioural Needs

Please write medication name(if held at school), Dosage, Frequency

Is your child immunized

Yes No

Please provide details of your child’s Immunisation records. This can be found in your child’s wellchild book, or alternatively you can ask your doctor for a digital copy of their records.

The school may administer panadol for pain relief

Yes No

I give permission for school staff to administer general first aid. I agree that the school will take action on my behalf in the event of a sudden medical emergency (illness or injury). Staff are not permitted to give any medication without consent.

Yes No

Custody/Access Arrangements

Court Order Issued

Yes No

Student's Birth Certificate/Passport

If Student was born overseas

Permissions

I have read and understood the privacy statement as below I give permission for Rangeview Intermediate School to share information on my child to their future potential intermediate or secondary school. I give permission for Rangeview Intermediate School to approach my child's current school to request information which could include academic, learning support and pastoral support.

I grant permission for my child to be used for promotional activities such as the school website, newsletter, prospectus, school magazine or local papers in the form of photographs or videos taken during the course of school activities e.g. sport, arts. Productions etc. Teachers may sometimes video themselves with students for professional learning activities.

Yes No

I give permission for my child to attend local trips outside the school property for educational purposes. I understand that any private car used will be registered and warranted and the driver will be licensed. This permission slip covers transport i.e. walking, private transport (where a seat belt is compulsory). The school will comply with the relevant sections of the Ministry of Education Outside the Classroom (EOTC) guidelines for good practice i.e. parent/teacher/child ratio.

Yes No

Privacy Statement

The information collected on this enrolment application will be used by the school for enrolment purposes and forms an essential part of the information held by the school on your child. All information collected around your child's enrolment 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 principles of the Privacy Act 2020. It will not be disclosed to any other person or agency unless such disclosure is authorised or required by law. Information collected may include academic, learning support and pastoral support. Privacy Act 2020 rights and obligations can be found at www.legislation.govt.nz

Cyber Safety Agreement

I have read the Cyber Safety agreement I have spoken with my child about the Cyber Safety agreement

By signing this below, I confirm that the information given in this form is true, complete and accurate.

Term Dates

Term 1 2023: Tuesday 31 Jan – Thursday 6th April

Term 2 2023: Monday 24 April – Friday 30 June

Term 3 2023: Monday 17 July – Friday 22 September

Term 4 2023: Monday 9 October – Tuesday 19 December

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Online Enrolment

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Online Enrolment