*Student Legal Surname

* Student Legal First Name/s

Student Prefered Surname if other than Legal Surname

Student Prefered First name if other than Legal First Name

*Gender

*Student Date of Birth

*Student Current Class/Year Level 0 1 2 3 4 5 6 7 8

*Student Address

Student Home Phone

*Student Ethnicity NZ European Maori Pacifica Asian NZ Other

Please write the ethnicity that best describes your child

Student Iwi Affiliations

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

*Student New Zealand Citizen/Residency Yes No

Please supply evidence by: Birth Certificate or Passport

Student Country of Birth

If not a NZ Citizen or Resident please complete.

*ECE Attendance Yes. Not regularly, only occasionally with no ongoing schedule. No, did not attend early childhood education.

Did your child attend Early Childhood Education regularly?

*ECE Type Did not attend. Kohanga Reo. Playcentre. Kindergarten or Education and Care Centre Home Based Service. Playgroup. Correspondence School Attended but outside NZ. Attended but do not know what type of service.

What type of Early Childhood Education did your child receive?

*ECE Years Attended None 6 months 1 year 18 months 2 years More than 2 years

How many years did your child attend an Early Childhood Education service?

*ECE Hours per Week None 1 to 5 hours 6 to 10 hours 11 to 15 hours 16 to 20 hours More than 20 hours

How hours per week did your child attend an Early Childhood Education service?

Previous Preschool

Please note the name of the preschool last attended by your child has had.

Previous School Name

Please enter the name and address of your previous school

*Proposed Starting Date

Please state when your child will start at Kapanui School.

Health:

Are there any health issues we should be aware of?

Family Doctor:

Please supply a current immunisation certificate.

Court Order (If Applicable) Not Applicable No Yes

Has a Court Order been issued?

Further Information (If Applicable)

Give any relevant information.

Learning and Behaviour (If Applicable)

Does your child have any major learning or behaviour needs that we should be aware of? Please give details

Specialist Resourcing/Agencies (If Applicable)

Is your child receiving or in need of receiving and specialist services and resources from any agencies? Please give details.

*First Caregiver 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

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

First Emergency Contact Name:

Contact number

Second Emergency Contact Name:

Contact number:

Admission Date:

Siblings Names and Dates of Birth (include preschool)

Please give details.