Online Enrolment Please note maximum Total file size allowed on this form is 8 MB. Student DetailsStudent's Name* First Last Student's Preferred Name First Last Date of Birth* DD slash MM slash YYYY Gender* Male Female Other If "Other", please specify* Previous School Address* Street Address Address Line 2 City Suburb Post Code EthnicityIwi/Hapu Affiliation Ethnic Group/s* Language Spoken at Home* Country of Birth* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Nationality* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Parent/Caregiver Details (1)Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Primary Caregiver* Yes No Relationship to Student* Address* Same as Student Home Address Street Address Address Line 2 City Suburb Post Code Occupation* Email* Home PhoneWork PhoneMobile Phone*Parent/Caregiver Details (2)Name Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Primary Caregiver Yes No Relationship to Student Address Same as Student Home Address Street Address Address Line 2 City Suburb Post Code Occupation Email Home PhoneWork PhoneMobile PhoneEmergency Contact (1)Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Relationship to Student* Phone*Emergency Contact (2)Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Relationship to Student* Phone*HealthAllergiesMedicationHearingVisionSpeechOther Health IssuesSpecial Learning and Behavioural NeedsImmunisation* Yes No Has your child had any speech or SES assistance prior to enrolment?* Yes No If yes, please provide details*Medical Center Name* Doctor's Name* Phone*Custody/Access ArrangementsCourt Order Issued* Yes No Court Order DocumentsAccepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Access ArrangementEarly Childhood EducationPrior-Participation in Early Childhood EducationPlease select (up to 3 services) for the last Early Childhood Education service(s) attended in the six months prior to starting school Kohanga Reo Play Center Kindergarten or Educations and Care Centre Home based service Playgroup The Correspondence School - Te Aho Te Kura Pounamu Name of Kohanga Reo* Hours per Week at Kohanga Reo* Name of Play Center* Hours per Week at Play Center* Name of Kindergarten or Educations and Care Centre* Hours per Week at Kindergarten or Educations and Care Centre* Name of Home based service* Hours per Week at Home based service* Hours per Week at Playgroup* Name of Playgroup* Name of The Correspondence School - Te Aho Te Kura Pounamu* Hours per Week at The Correspondence School - Te Aho Te Kura Pounamu* DocumentsProof of in zone address*Council rates, water care, electricity bill etc.Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Student's Birth Certificate/Passport*If student is a New Zealand citizenAccepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Student's Passport*If student is not a New Zealand citizen.Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Parent's Passport*If student is not a New Zealand citizen.Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Parent's Visa*If student is not a New Zealand citizen.Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Immunisation Documents*Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Additional FieldsTransport Walk Bike Car Taxi Bus Nine Mile Charleston Carters Beach Waimangaroa SiblingsPrivacy & PolicyPermissions* Select All I agree to the Westport South School collecting personal information on the student registered on this form. I have been advised by the School that the information I provide will be used to enable Westport South School’s Board of Trustees to carry out its objectives as set out in the Charter, the National Educational Guidelines and legislation - particularly the Education Act. I accept the fact that this information may later be used for statistical and/or research purposes and agree to its use for that purpose, provided that if the information is published in any way it will not identify me or the individual concerned. I understand that the information that I provide will be held at Westport South School whose address is: Westport South School, Derby Street, WESTPORT. I am aware of the rights of access to, and correction of this information. I give permission for my child to participate in class excursions and the school swimming programme at the town pool. (Notification will be sent home prior to excursion). I agree to my child having access to the internet through the school’s computers in accordance with the schools internet safety procedure. I give the school permission to publish any photos taken while my child is at South School (class blogs, website, newspaper, google docs). In the event of an emergency I give permission for the school to act on my behalf* Yes No I give permission for the school to administer paracetamol to my child.* Yes No SignatureBy signing this below, I confirm that the information given in this form is true, complete and accurate.Full Name* Relationship to Student* Date* DD slash MM slash YYYY CAPTCHANameThis field is for validation purposes and should be left unchanged.