Enrolment Form 1 STUDENT DETAILS2 LIVING & ELIGIBILITY3 FAMILY INFORMATION4 DECLARATION ENTRY YEAR*Select20202021YEAR LEVEL*Select910111213FIRST NAME*LAST NAME*PREFERRED NAMEDATE OF BIRTH* Date Format: DD slash MM slash YYYY STUDENT MOBILESTUDENT EMAIL ADDRESS Enter Email Confirm Email ETHNICITY*NZ EuropeanNZ Maori*British and IrishDutchGreekItalianGermanAustralianOther EuropeanSamoanNiueanFijianOther Pacific IslandFilipinoCambodianChineseIndianJapaneseKoreanOther AsianMiddle EasternAfricanOther – specify to the rightPolish* IWI/TRIBAL AFFILIATION*OTHER*STUDENT IS CURRENTLY ATTENDING NAME OF SCHOOL*PRESENT YEAR LEVEL*HEALTH INFORMATION DOES THE STUDENT HAVE A MEDICAL CONDITION, DISABILITY OR ALLERGY THE SCHOOL SHOULD BE AWARE OF?*YesNoFURTHER DETAILS*I GIVE PERMISSION FOR MY SON TO BE GIVEN PARACETAMOL*YesNoI GIVE PERMISSION FOR MY SON TO BE GIVEN IBUPROFEN*YesNoOTHER INFORMATION OTHER INFORMATION DOES THE STUDENT RESIDE IN THE SCHOOL ZONE?*YesNoWe require two forms of proof eg a rental agreement, rates statement, power or phone account.STUDENT RESIDES AT*One AddressTwo AddressesHAS THE STUDENT HAD A BROTHER OR FATHER WHO PREVIOUSLY ATTENDED OR CURRENTLY ATTEND SBHS?*YesNoNAME*RELATIONSHIP*CURRENT/YEARS ATTENDED* PARENTS/CAREGIVERS AT RESIDENCE 1 PARENT/CAREGIVER 1* First Last RELATIONSHIP TO STUDENT*SelectMotherFatherCaregiverOtherMOBILEEMAIL ADDRESS* PARENT/CAREGIVER 2 First Last RELATIONSHIP TO STUDENTSelectMotherFatherCaregiverOtherMOBILEEMAIL ADDRESS HOME TELEPHONEHOME EMAIL ADDRESS RESIDENTIAL STREET ADDRESS*POSTAL ADDRESS (if different from street address)PARENTS/CAREGIVERS AT RESIDENCE 2 PARENT/CAREGIVER 1* First Last RELATIONSHIP TO STUDENT*SelectMotherFatherCaregiverOtherMOBILEEMAIL ADDRESS* PARENT/CAREGIVER 2 First Last RELATIONSHIP TO STUDENTSelectMotherFatherCaregiverOtherMOBILEEMAIL ADDRESS HOME TELEPHONEHOME EMAIL ADDRESS RESIDENTIAL STREET ADDRESS*POSTAL ADDRESS (if different from street address)Additional contact details eg parent not living with student I want to add additional contact details NAME First Last RELATIONSHIP TO STUDENTSelectMotherFatherCaregiverOtherTELEPHONEEMAIL ADDRESS MOBILERESIDENTIAL STREET ADDRESSPOSTAL ADDRESS (if different from street address)EMERGENCY CONTACT DETAILS (Relative, friend or neighbour who can be contacted) NAME First Last RELATIONSHIP TO STUDENTSelectMotherFatherCaregiverOtherTELEPHONEMOBILEOTHER INFORMATION OTHER INFORMATION CONDITIONS OF ENROLMENT* I hereby make application to enrol this student at Shirley Boys’ High School under the terms and conditions of enrolment (contained in the school prospectus), including the school rules and guidelines, which I accept as applying to him (and I accept these may change from time to time). I will ensure the student attends regularly. I consent to my son participating in on-site EOTC activities (on the school grounds) e.g. science experiment, indoor climbing wall. I consent to the disclosure of basic student information such as Name, User ID, School Photo, Username, School Email, Timetabling information and Results to third parties for the purposes of providing online educational services provided that they have an agreement including privacy provisions with either Shirley Boys’ High School or the Ministry of Education. I consent to the school using photographs of the student for publicity purposes. In line with the unsolicited Electronic Messages Act 2007, I consent to Shirley Boys’ High School communicating with me via electronic messages as a means of reporting and general communication as they deem appropriate. I have read and accept the ICT Responsible use agreement the student will be expected to read and agree to by signing. I certify that all information entered on this enrolment form is correct Ticking this box constitutes acceptance of the above conditions of enrolment and execution by electronic signature. IN-ZONE DECLARATION I confirm that the address which I have provided to the school will be the student’s usual place of residence when the school is open for instruction. I will advise the school of any subsequent change of address The address given at the time of application for enrolment must be the student’s usual place of residence when the school is open for instruction. This means that if you currently live at an in-zone address but move to an out-of-zone address before your child’s first day of attendance at the school, your child will not be entitled to enrol at the school as an in-zone student. The Ministry of Education has advised that parents should also be warned of the possible consequences of deliberately attempting to gain unfair priority in enrolment by knowingly giving a false address or making an in-zone living arrangement which they intend to be only temporary eg: renting accommodation in-zone on a short-term basis with the purpose of providing an in-zone address; arranging temporary board in-zone with a relative or family friend; using the in-zone address of a relative or friend as an “address of convenience”, with no intention to live there on an ongoing basis. If the school learns that a student is no longer living at the in-zone address given at the time of application for enrolment and has reasonable grounds to believe that a temporary in-zone residence has been used for the purpose of unfairly gaining priority in enrolment at the school, then the Board will review the enrolment and can result in the removal of the student from the school roll. The school has the right, and will, investigate in-zone enrolments if required. This course of action is provided for under Section 110A of the Education Act 1989. FILE Drop files here or Accepted file types: pdf, doc, docx, jpg, gif, png. Please attach a copy of the student’s birth certificate. If born outside NZ or Australia, a copy of the student’s passport and Permanent Resident permit or Study Visa should be provided. Copy of most recent school report. For in-zone applications please attach two forms of proof. Files uploaded must be one of the following file types: .pdf, .doc, .docx., .jpg, .gif or .pngPhoneThis field is for validation purposes and should be left unchanged.