2014 Rumaki Enrolment Form - Kowhai Intermediate School

kowhai.school.nz

2014 Rumaki Enrolment Form - Kowhai Intermediate School

KOWHAI INTERMEDIATE SCHOOL26 Onslow Road, Kingsland, AUCKLAND 1024Principal: Paul DouglasPhone: 09 846 7534ENROLMENT 2014Fax: 09 846 7918Email: admin@kowhai.school.nzRumaki Reo MaoriStudent’s Full Name: ……………………………………………………………………………………… …………………………………………First Name Middle Name Legal Family NameKnown As: ………………………………… ………………………………… Date of Birth: ……… / ……… / ………Preferred First Name Preferred Family Name Day/Month/YearCopy of Birth Certificate Supplied: …………………………… Gender: Male / FemaleAddress: ……… …………………………………………………………………… ……………………………………… …………………………No. Street Suburb Post CodePostal Address: …………………………………………………………………………………………………………………………………………………Current Siblings at Kowhai: ………………………………………… Former Siblings at Kowhai: ……………………………NameNameHome Phone: ………………………………………………………………… Mobile Phone: ……………………………………………………Email Address: ……………………………………………………………… Country of Birth: ………………………………………………Country of Citizenship: …………………………………………………First Language: ……………………………………………………………… Other Languages: ……………………………………………Language spoken at homePrevious School: …………………………………………………………… Class Level at Previous School: ……………………Ethnicity: 1. …………………………………………… 2. ……………………………………………… 3. ……………………………………………Main group you identify with — African, Australian, British/Irish, Cambodian, Chinese, Cook Island Maori,Dutch, Fijian, Filipino, German, Greek, Indian, Italian, Japanese, Korean, Latin American, Maori, Middle Eastern,Niuean, NZ European, Pakeha, Other Asian, Other Ethnicity, Other European, Other Pacific Peoples, OtherSoutheast Asian, Polish, Samoan, South Slav, Sri Lankan, Tokelauan, Tongan, Vietnamese.This section must be completed if the student is Not Bornin New ZealandDate Entered New Zealand: ………./………/………Residency Status: NZ Citizenship / NZ Permanent Residence/ Student Visa (Please Circle)Page 1


ADULT/S WITH WHOM STUDENT LIVES:Caregiver 1: Relationship …………………………………………Surname: ……………………………………………………………………First name: …………………………………………………………………Occupation: …………………………………………………………………Work phone: ………………………………………………………………Mobile phone: ………………………………………………………………Email Address: ……………………………………………………………………Caregiver 2: Relationship………………………………………………Surname: …………………………………………………………………………First name: ………………………………………………………………………Occupation: ……………………………………………………………………Work phone: ……………………………………………………………………Mobile phone: …………………………………………………………………Email Address: …………………………………………………………………………PARENT NOT LIVING WITH STUDENT (If applicable—Required for Board of Trustees Electoral Roll)Relationship: ………………………………………………………………Surname: ……………………………………………………………………First name: …………………………………………………………………Mobile phone: ……………………………………………………………Receive copy of School Report or Notices: Yes / NoAddress: ……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Email Address: …………………………………………………………………Shared custody: Yes/No ……………………………………………EMERGENCY CONTACTS:It is important that the school is able to make contact with parents/caregivers in an emergency. Please supply two(2) emergency contacts different from adults with whom student lives.Emergency contact 1: Relationship ……………………………Surname: ………………………………………………………………………First name: ……………………………………………………………………Phone: …………………………………………………………………………Mobile phone: ………………………………………………………………Emergency contact 2: Relationship ……………………………Surname: ………………………………………………………………………First name: …………………………………………………………………Phone: ……………………………………………………………………………Mobile phone: …………………………………………………………………MEDICAL INFORMATION:Doctor: ……………………………………………………………………………Phone Number: ……………………………………………………………Medical Problems/Allergies: Degree: (e.g. mild, moderate) Medication Required:………………………………………………… ………………………………………………… ……………………………………………………………………………………………………………… ………………………………………………… ……………………………………………………………Please detail any other prescription medication that the student uses: ……………………………………………………………Ok for School to administer Panadol: Yes / NoIn case of severe medical conditions: Please attach a copy of your child’s medical plan or an action plan (shortsummary) in case of an emergency.LEARNING / BEHAVIOUR NEEDS: Please state any special learning, ability or behaviour needs your child may have.…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Other involvement: (RTLB / KARI / ESOL / MOE Special Education / IEP) …………………………………………………………Page 2


Senior Teacher: Tere TamaruaPhone: 09 846 9035Whanau PounamuNga reo, nga mana nga rangatira ma Tena koutou. Tena koutou i runga i te rangimarie me te aroha ara, i runga i te kaupapa kia whakauru mai totamaiti ki te Whanau nei.It is important for all new students to have a ‘Whakaheke’ that they affiliate to. This in some way gives them a link to the ideology of where theyoriginate from, and therefore an affiliation to what we are trying to do here, using the concept of ‘whanau’. This must be known by all students priorto their arrival to us.Please fill in the following:Ko wai tō iwi? (Which is your Iwi?)............................................................................................................................................................................................Ko wai tō waka? (What is your canoe?)Ko ...................................................................................................... toku waka.Ko wai tō awa? (What is the name of your river/sea?)Ko ....................................................................................................... toku awa.Ko wai tō whare/marae? (Who is your ancestral house/place to stand?)Ko ....................................................................................................... toku whare/marae.Ko wai o/tō tipuna? (Who is/are your ancestors?)Ko .............................................................. ……………………………..toku/oku tipuna.Ko wai tō maunga? (Who is your mountain?)Ko ....................................................................................................... toku maunga1. Please fill in this grid, detailing previous schools enrolled at, Kohanga — primary.NAME OF PREVIOUSKohanga / SchoolYEARS ATTEND KAIAKO WAS IT BILINGUAL /RUMAKI2. Reo Maori proficiency - Please discuss this with your child and then indicate.Bilingual1 beginner 2 3 4 5RumakiReo1 beginner 2 3 4 5Has no Maori LanguageDo you speak Maori to your child at home? YesNoDoes your child have someone to support them in there Reo outside of school? Yes NoWho?....................................................................................All parents/caregivers of the unit are expected to attend regular hui to discuss the running of the unit. Are you willingto attend at least one hui per term? Yes NoPlease explain briefly your reasons for enrolling your child in Te Whanau Pounmu.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................What are your expectations for your child’s education over the next 2 years?....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................Page 3


Interview process:Interview process will take 30 minutes. This will include an oral proficiency test. Please provide your Childs latest school report,including their Panui, Tuhi, Korero results.There are two Rumaki classes and a Hapai Reo class.Maximum for each class is 25 students.Parent / Caregiver Declaration:I declare that:I have completed all relevant sections of the above form and the information supplied is correctI have supplied copies of documentation where applicable (i.e. Birth Certificate, Passport etc.)I will assume responsibility for the school donationMy child will attend school regularlyMy child will abide by the school’s rules, including the wearing of the correct Kowhai Intermediate School uniformI understand that:The information on this form will be used by the school for educational purposesI am giving my permission for the school to include my child in routine health checks when necessaryI am giving my permission to enable the dental authority to access my child’s detailsMy child’s caregivers, names, addresses and phone numbers may be released to the BOT.I give permission for:My child’s records to be obtained from their previous schoolMy child’s records to be sent on to their next school upon their leaving Kowhai Intermediate.The information I have provided on this application is true and correct, by virtue of the Oaths and Declarations Act1957.Signature of Parent / Caregiver: …………………………………………………... Date: …………………………Name: (Please print) ………………………………………………………………………………PARENT— CHECK LISTAll relevant documentation has been supplied:Full Birth Certificate or NZ Passport Serial number: ……………………...Copy of Proof of address (Power bill/Telephone bill, etc.)Copy of the student’s last School ReportCopy of Proof Sensitive Information (court orders, shared custody etc.) if applicableCopy of Medical plan / short summary (Severe medical conditions) if applicableIf your child is not born in New Zealand, the following documentation isrequired!Passport of country of Citizenship Serial number: ………………………Student Visa or Permanent Residence Permit or Citizen Certificate:Serial number: ………………………Expiry date: ………/………/…………….If the child is living with Caregivers other then the biological parents, documentation is required to support this arrangement.Legal adoption papers /court order or formal letter from parents explaining livingArrangements.Full birth certificateOffice Use Only:Date Application received ……/……/………………(Starting Date: ……………/……………/………… ICT Teacher informed: ………………Year: …………… Room: ………… ESOL Teacher informed: ……………Enrolment No.: ………………………………Entered in MUSAC: …………………Entered in ENROL: ………………National Student Number ……………………………WITHDRAWN/LEAVERDate …………/ …………/………Reason: ……………………………………………Intended Destination School: ………………………………Page 4

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