Wesley Intermediate School
Enrolment Form
766 Sandringham Road Extension
Mt Roskill
09 6209367
admin@wesleyintermediate.school.nz
Student Details: Start of Enrolment form
Please start here and try to complete all the questions required when completing the enrollment form.
Where applicable you may need to provide and or send a copy of supporting documents eg. passport/ birth certificate
Current Year Level
Please tick your child's current year level.
Surname *
Fill in the box below
First Name/s *
Fill in the box below
Preferred name
Fill in the box below
Male or Female *
Tick one
Required
Date of Birth *
Please enter day/month/year
MM
/
DD
/
YYYY
Country of Birth *
Please write the child's country of birth below and also attach a photo copy of their passport or birth certificate for verification
Ethnicity *
Please tick the enrolling student's ethnicity
Required
If you have selected Maori
Please write the Iwi below-
First Language *
Please write the language the student is most fluent in
Other Languages *
Please write any other language/s the enrolling student is able to speak
Date of arrival in New Zealand
Only complete If the student was NOT born in NZ
MM
/
DD
/
YYYY
Parent/Caregiver Details
Please complete this section with the parent or caregiver details. If any of the details change please remember to update the school office ASAP
Please indicate who is the Primary Caregiver of this child *
Please tick who will be the best person to contact regarding this enrollment.
Primary Caregiver's Surname *
Please write the surname below
Primary Caregiver's First Name *
Please write the first name below
Address *
Please write your home address
Email address *
Please write your email address
Occupation
Please write your occupation
Home Phone number *
Please write the home phone number
Mobile *
Please write your mobile phone number
Please indicate who is the Additional Caregiver of this child *
Please tick who will be the best person to contact regarding this enrollment.
Additional Caregiver's Surname *
Please write the surname below
Additional Caregiver's Surname *
Please write the surname below
Additional Caregiver's First Name *
Please write the first name below
Address *
Please write your home address if different from Mother's
Occupation
Please write occupation or description of job
Home Phone number
Please write the home phone number if different from Primary caregiver
Mobile Number
Please write the mobile phone number
Emergency Contact
In an emergency, we may be required to contact another family member or support person, should the primary caregiver be unavailable. Please complete their details below.
Name of Emergency Contact *
Please write the full name of your emergency contact
Phone Number *
Please write the emergency contact's phone number
Relationship to Child *
Please write the emergency contacts relationship to the student
Health information
We are required to collect information about the students health needs, so that we may be able to best provide the support needed at school.
Doctors Name
Please write the name of the family doctor and surgery name
Medical Information and Conditions to note
Please write down any medical information eg. Allergies, disabilities, medication
Access Restrictions
If the student requires support due to a disability, please indicate below
I give permission for my child to be given parecetamol (panadol) if I cannot be contacted *
Please indicate if you agree or disagree
Previous School Information
Required information from Previous school, please attached the most recent school report and other supporting documents as needed
School Name *
Please write the students previous school before WIS
Year Level *
Please indicate the students previous school year level
Siblings attending WIS
Please indicate the student's siblings that currently/have attended the school
Suggestions for class placement
Please write any suggestions about which students should or should not be in the same class as your child
Other information
Custody Arrangements
Please tick your answer, if you tick Yes- please attach a copy along with your other supporting documents
Clear selection
Court Order
Please tick an answer, if you tick Yes- please attach a copy along with your other supporting documents
Clear selection
Other Agencies
Please write if any other agencies have been involved in supporting the enrolling student eg RTLB, NURSE, CYFs
Declaration *
I understand that Wesley Intermediate School will take action on my behalf in case of sudden illness or injury and I agree to abide by school policies. I will advise the school and give permission should administration of medication be required at school. In terms of the Privacy Act, I understand that the information on this form is collected to form part of the essential information Wesley Intermediate School holds on my child. I approve of Wesley Intermediate School obtaining information from my child’s previous school and forwarding information to the next school. I approve that appropriate digital information, including videos/photos of my child maybe used to promote the learning within the school. The records from this information may be viewed on request at the school. I agree that my child will be dressed in the school uniform and abide by all the School Values as outlined in the Wesley Intermediate School Enrolment Pack. I certify that all the information written in this enrolment form is accurate.
Office Use Only
This section will be completed by WIS administration staff only
NSN Number
Fill in the box below
ESOL Number
Fill in the box below
Refugee status
Please tick
Admin staff to check
Only tick if the documents have been received/approved
Submit
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