1. STUDENT
Please enter all
Student
details.
DOB DAY
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
DOB MONTH
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
DOB YEAR
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
YEAR
YEAR 5
YEAR 6
YEAR 7
YEAR 8
ETHNICITY
KIWI
NZ MAORI
SAMOAN
COOK ISLAND MAORI
TONGAN
NIUEAN
FIJIAN
TOKEKAUAN
SOUTH EAST ASIAN
CHINESE
INDIAN
OTHER
Please identify main contact details, email, home and mobile number and where student resides.
STUDENT RESIDES WITH
MOTHER AND FATHER
MOTHER
FATHER
CAREGIVER/GUARDIAN
2. MEDICAL/EMERGENCY
Please complete
Medical details
in cases of emergency .
Please complete an
Emergency
Contact Person
in an emergency if parents/caregivers are not available.
3. MOTHER/FATHER
Please fill in all
Mothers
Details.
Please fill in all
Fathers
Details.
4. CAREGIVER
Complete this section only if student is living with a caregiver, starting with
First Cargiver
details.
Please provide
Second Cargiver
details.
5. DECLARATION
Please complete if student was not born in New Zealand, date arrived in New Zealand or Residential Visa No., Passport No., or Permanant Residence No., or Student Visa No.
DAY
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
MONTH
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
YEAR
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Please tick the boxes where you agree with the following:
I/We agree to:
Please select your childs clothing size. NB: This is used as an indicator only for stock purchasing.