TNIS Learner Covid Vaccination Status Declaration
Returning To School
So that we can plan appropriately, we will also be asking you to indicate your intentions around sending your child back to school.

The Ministry of Education has made it a requirement for all schools to keep a vaccination register for its students. This is a confidential register which will help to keep our school as safe as possible. You are invited to disclose your student's vaccination status, however students will be deemed unvaccinated it the information is not provided, the box is checked that your student is under the age of 12 or proof of vaccination is not included.

Privacy Statement: Vaccination Register
The purpose of this privacy statement is to inform you about how we will collect, store, use and share your personal information for the purposes of our Eligible Student Vaccination Register.
Why are we collecting your personal information?
Under the Covid-19 Public Health Response (Vaccinations) Order 2021 (the Order), intermediate schools are required to maintain an up-to-date register with the vaccine status of all eligible students.
How will we use your personal information?
Your vaccination status information will enable us to know the vaccination status of all eligible students to ensure we are complying with the Order, and in the case of an outbreak, respond accordingly.

Where no information is provided your record in the Vaccine Register will note that no information has been provided.

How will we collect this information?
We will collect this information directly from the parents/caregivers via this survey.

How will we keep personal information safe?
It is important that we keep your vaccination information safe and secure. We maintain a secure environment for the protection of all personal information we hold and use appropriate security safeguards to protect information from loss, unauthorised access, use, or disclosure.
Only authorised staff will have access to the Vaccination Register, and access to the information in the Vaccination Register will only be for authorised purposes.

Sharing of personal information
We will not share this information unless we are required or authorised to do so by law.
In the situation of an outbreak, we may share your personal information with a Public Health Authority for the purposes of planning and implementing appropriate public health responses. Where possible we will only disclose aggregate level information.
We may disclose aggregate level information to the Ministry of Health and the Ministry of Education to assist those agencies to monitor and plan Covid-19 responses. You will not be identified in any disclosure of information to these agencies.

How long will we keep this personal information?
We will not keep your information for longer than is required for the purposes stated above.

Your rights under the Privacy Act 2020
Under the Privacy Act, you have the right to request a copy of, and correction to, any personal information held by us. You can do this by emailing us at

Please complete this form ASAP and BEFORE your student returns to school
Email *
Child's first name: *
Child's last name: *
Child's date of birth: *
Room number *
Vaccination Status (Select one only) *
It is my intention to: *
Parent/ Caregiver Full Name *
Parent/Caregiver Email *
Parent/Caregiver Phone *
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This form was created inside of Takapuna Normal Intermediate.