Enrolment Form for new students - Timaru Boys High School

Student DetailsFAMILY NAME:GIVEN NAME (S):PREFERRED NAME:HOME ADDRESS:TIMARU BOYS’ HIGH SCHOOLENROLMENT FORMYear 20 ____FOR ADMIN PURPOSES ONLYForm Class: _____________DATE OF BIRTH:Date Starting: ___/___/___NSN NUMBER:Copy of full birth certificate attachedPLACE OF BIRTH:COUNTRY OF CITIZENSHIP:POSTCODE:HOME PHONE: STUDENT CELL PHONE #:CURRENT SCHOOL:CURRENT YEAR LEVEL:To be enrolled as a Day Student BoarderParent (s) or Caregiver (s) student lives withFULL NAME: Mr, Mrs, Ms, Miss, Dr:Relationship to student:Home E-Mail Address:Name of Workplace:FULL NAME: Mr, Mrs, Ms, Miss, Dr:Relationship to student:Home E-Mail Address:Name of Workplace:Mail Addressed to Whom:If from overseas copy of fullPassport/Visa attachedOccupation:Cell Phone:Parent (s) or Caregiver (s) student does not live with (if applicable)FULL NAME: Mr, Mrs, Ms, Miss, Dr:ADDRESS:Relationship to student:Home E-Mail Address:Name of Workplace:Emergency ContactNAME: Mr, Mrs, Ms, Miss, Dr:Address:POSTCODE:Work Phone:Occupation:Cell Phone:Work Phone:Home Phone:Cell Phone:Occupation:Work Phone:Relationship to student:Home Phone: Cell Phone: Work Phone:Ethnicity (Cultural identification with a particular ethnic group.) Dual ethnicity may be selected.NZ European NZ Maori Iwi – Please provide affiliation belowOther Please specify ___________________________________________________________________________________________________

Family / School Links (Past / Present) _______________________________________________________________Preferred House (Dawson / Hogben / Simmers / Tait __________________________________________________Student’s Academic Interests & AchievementsSporting and Cultural Interests of the StudentSkills / Support Family can offer school(e.g. assist with volunteer help, transport, PTA, coaching, etc) __________________________________Student’s Health RecordDoctor:Surgery Phone Number:Dentist:Surgery Phone NumberHas the student ever suffered from Severity Medication RequiredAsthma (Circle one) Yes/NoDiabetesYes/NoEpilepsyYes/NoADD / ADHDYes/NoMigraineYes/NoAny other medical condition or disability?Does the student suffer an allergic reaction toAllergy to: Severity Medication RequiredStingsFoodMedicationOther:In Case of Illness, Accident or EmergencyI give permission for my child to receive non prescription medicines such as Panadol, whennecessary, from a staff member who holds a current First Aid CertificateIf the school is unable to contact you, or if the accident is serious, I give permission for theschool to either take my child to a Medical Centre or call an ambulance. If an ambulanceis needed for a non-accident incident I agree to meet any costs incurred.Yes / NoYes/No(Circle one)(Circle one)Rural Bus Student: (Circle) YES / NO If YES please tick Bus Route below.Claremont 7599Opihi/Taiko 7643Southburn 7745Kerrytown 7558Otaio/St Andrews 7688Temuka 7597Levels Valley 7647Pareora East 7686Upper Waitohi 7637Lyalldale 7598Rosewill Valley 7636Waimate 7741Maungati 7689Seadown 7735Waipopo 7687

CybersafetyI have read and understand my responsibilities and agree to abide by this Cybersafety Use Agreement. I know that if I breach thisuse agreement there may be serious consequences.Name of student: _______________________________Year Level: ___________Signature: ________________________________ Date: ___________________Section for parent/legal guardian/caregiverMy responsibilities include:I will read the Cybersafety Use Agreement document carefully and discuss it with my son so we both have a clearunderstanding of my son’s role in the school’s work to maintain a cybersafe environmentI will ensure this use agreement is signed by my son and by me, and returned to the schoolI will encourage my son to follow the cybersafety rules and instructionsI will contact the school if there is any aspect of this use agreement I would like to discuss.I have read this Cybersafety Use Agreement document and am aware of the school’s initiatives to maintain a cybersafe learningenvironment, including the responsibilities involved.Parent/Legal Guardian/CaregiverName: ________________________________________________Signature: _____________________________________________ Date: ____________________________________NB: A full version of the Cybersafety Use Agreement is available and can be viewed at www.timaruboys.school.nzPermission for Education Outside the ClassroomThe education outside the classroom procedures require that we ask you for written permission for your son toparticipate in;Level 1 - off site events that occur during the school day or finishing after school. These events have an element ofrisk deemed to be no greater than the average family activity. Examples include; Interschools, Careers day, or anArt class trip to a gallery.You will still be given information sheets (cost, time, date) by the teacher in charge and you have the right towithdraw your permission at any time by contacting the teacher in charge.Full written permission is still required for each individual where the activities risk is deemed to be greater than alevel 1, including any overnight stay. Examples include; tramping, rock climbing, water activities. Teachers in chargewill complete Risk Analysis Management procedures for these events in accordance with school policy.Parent / Caregiver Signature _________________________________________________School AccountsAccounts are posted out monthly and the school requires that they are paid promptly. Regular automatic payments areencouraged. Books and curriculum materials are to be paid for on issue and sport and outdoor events must be paid prior to thestudent participating. Where serious difficulties arise regarding payment of fees, parents may negotiate in confidence with theRector or Business Manager.Privacy StatementThe information on this form is collected to form part of the essential information the school holds on your child. Theinformation collected will be used by the school for the following purpose: enrolling your child at school, assessing theeducation needs of your child and ensuring that education services and resources in respect of your child are provided to theschool.The records made from this information may be viewed on request at the school. The information collected may be disclosedto education and health sector agencies in accordance with the principles of the Privacy Act. Except with your specificauthorisation, it will not be disclosed to any other person or agency unless such disclosure is authorised or required by law.DeclarationI wish to enrol the above named student. I have read the School Prospectus and undertake to ensure that myson abides by the regulations and expectations of the school and Board. All Board policies are available for yourconsideration at the school office or on the School Website.Signature _______________________________Mother / Father / Caregiver Date:____/____/____

Academic - Subjects EnjoyedTO BE COMPLETED AT INTERVIEW(Between family, student and senior staff member)Areas for Improvement:InterestsMusic/Drama/ArtSportingRELEVANT HOME CIRCUMSTANCES (including place in family)COPIES OF REPORTS TO BE SENT TOOTHER INFORMATIONSUBJECT OPTION COURSES1. 2. 3.4. 5. 6.Meeting attended by ________________________________________________________ Date:___/___/___Checklist for Interviewing Staff MemberCopy of Birth Certificate attachedIf from overseas – copy of Passport and Visa attachedOFFICE USE ONLY - ENROLMENT CHECKLISTTask Action Date InitialPre-enrolment entered on SMBasic DataFull DataNew Enrolment entered on SMFull DataCopy to Year Level DeanTimetable preparedEntered on ENROLComputer Account Requested