Enrolment Information

Paekakariki School Enrolment Form

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*First Name

*Family Name

*Date of Birth

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*Ethnicity NZ European Maori Pacifica Asian NZ Other

Please write the ethnicity that best describes your child.

*Born in New Zealand Yes No

Please supply evidence by: Birth certificate or Passport

Iwi Affiliations

If you have classified your as child Maori can you please write down any Iwi affiliations

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Proposed Starting Date

Please state when your child will start at Paekakariki School.

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Caregiver Details

*Name:

*Address

Occupation

Home Telephone Number

Work Telephone Number

Cell phone

Email Address

Please type your email address here.

Would you like our newsletter emailed to you? Yes No

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Second Caregiver

Name

Address

Occupation

Home Telephone Number

Work telephone number

Cell phone:

Email Address

Would you like our newsletter emailed to you? Yes No

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Emergency Contacts

Name:

Contact number

Name:

Contact number:

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Preschool

*Preschool Attendance

Please note down any preschool involvement your child has had.

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Health

Health:

Are there any health issues we should be aware of?

Family Doctor:

Please supply a current immunisation certificate.

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Administration

Administration Only: Year

Room Number

Admission Number

Admission Date:

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