Online Enrolment Form – Silverdale School

Term Dates 2024 Term 1: Wed 7 Feb – Fri 12 AprTerm 2: Mon 29 Apr – Fri 5 JulTerm 3: Mon 22 Jul – Fri 27 SepTerm 4: Mon 14 Oct – Thur 19 Dec

Please note maximum Total file size allowed on this form is 8 MB.

Please put N/A in the fields that do not apply.

Student Details
Student's Legal First Name*
First
Student's Legal Last Name*
Last
Student's Preferred First Name*
First
Student's Preferred Last Name*
Last
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Another Gender
- Not Stated
Current Year Level*
Current School*
Eldest Child at Silverdale School*
Address*
Street Address Address Line 2 City Suburb Post Code
Ethnicity
Iwi/Hapu
Affiliation
Ethnic Group/s*
Language Spoken at Home*
(If Chinese please specify if Mandarin or Cantonese)
Country of Birth*
Country
Nationality*
Country
Date of Entry into NZ*
DD slash MM slash YYYY
Date of Student's Visa*
DD slash MM slash YYYY
Date of Parent's Work Permit (1)*
DD slash MM slash YYYY
Date of Parent's Work Permit (2)*
DD slash MM slash YYYY
Parent/Caregiver Details (1)
Name*
Prefix First Last
Primary Caregiver*
- Yes
- No
Relationship to Student*
Address*
Same as Student Home Address

Street Address Address Line 2 City Suburb Post Code
Occupation*
Email*
Home Phone*
Work Phone*
Mobile Phone*
Parent/Caregiver Details (2)
Name
Prefix First Last
Primary Caregiver
- Yes
- No
Relationship to Student
Address
Same as Student Home Address

Street Address Address Line 2 City Suburb Post Code
Occupation
Email
Home Phone
Work Phone
Mobile Phone
Emergency Contact (1) - alternative to parent/caregiver
Name*
Prefix First Last
Relationship to Student*
Address*
Street Address Address Line 2 City Suburb Post Code Country
Home Phone*
Work Phone*
Mobile Phone*
Emergency Contact (2) - alternative to parent/caregiver
Name*
Prefix First Last
Relationship to Student*
Address*
Street Address Address Line 2 City Suburb Post Code Country
Home Phone*
Work Phone*
Mobile Phone*
Health
Allergies*
Medication*
Hearing*
Vision*
Speech*
Other Health Issues*
Special Learning and Behavioural Needs*
Immunisation*
- Yes
- No
Custody/Access Arrangements
Court Order Issued*
- Yes
- No
Court Order Documents*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Access Arrangement*
Early Childhood Education
Did your child attend Early Childhood centre?*
- Yes
- No
Prior-Participation in Early Childhood Education*
Please select (up to 3 services) for the last Early Childhood Education service(s) attended in the six months prior to starting school
- Kohanga Reo
- Play Center
- Kindergarten or Educations and Care Centre
- Home based service
- Playgroup
- The Correspondence School - Te Aho Te Kura Pounamu
Hours per Week at Kohanga Reo*
Hours per Week at Play Center*
Hours per Week at Kindergarten or Educations and Care Centre*
Hours per Week at Home based service*
Hours per Week at Playgroup*
Hours per Week at The Correspondence School - Te Aho Te Kura Pounamu*
Please write the name of the Early Childhood centre*
Please write the number of years attended for each ECE(s)*
Documents
Proof of in zone address*
Council rates, water care, electricity bill etc.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Birth Certificate (MANDATORY)/Passport*
If student is a New Zealand citizen
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Passport*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Birth Certificate*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Parent's Passport*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Parent's Visa*
If student is not a New Zealand citizen.
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Immunisation Documents*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Silverdale Orewa Kahui Ako Learner Support Consent*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Digital Citizenship Agreement*
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Report from previous school (if available)
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Additional Fields
Future Sibling Enrolment Details (Please write full name & date of birth)*
Privacy & Policy
Permissions*
- I give permission for my child's image to be used where appropriate. Eg. newsletter, school website, classroom displays etc.
- I give permission for the school staff to administer general first aid. Staff are not permitted to give any medication without a separate signed consent form.
- I give permission for my email to be used for newsletters, notifications, fundraising, initiatives and emergencies such as evacuations and lockdowns etc.
- I consent that the relevant information can be sent to the Returning Officer for the preparation of the Electoral Roll. This information may be used for the Silverdale School Board election purposes only.
Privacy Statement
The information collected will be used by the school for enrollment and forms an essential part of the information held by the school on your child. The records made from this information may be viewed on request at the school. The information collected may be disclosed to appropriate education, health and welfare authorities and for data-gathering purposes by the New Zealand Ministry of Education, in accordance with the principles of the Privacy Act. It will not be disclosed to any other person or agency unless such disclosure is authorised or required by law.
Parent Declaration
I agree that the school will take action on my behalf in case of sudden illness or injury, to abide by the school’s policies, that my child’s work and image may be used in accord with the school’s online publishing policy/procedures and that the school may forward my child’s name and address to a potential intermediate or secondary school. All information that I have provided is true and correct.
Signature
By signing this below, I confirm that the information given in this form is true, complete and accurate.
Full Name*
Date*
DD slash MM slash YYYY
Enrolment Information for In Zone Students
Statutory Declaration for In-Zone Enrolments
I, (name stated below) being the parent /guardian*
of (student name stated below) do solemnly declare as follows.*
That the information contained in this enrolment is true and correct in every respect. (Please tick the box)*
1.Any change to any information provided in this form prior to the student being first marked as present on the School roll will be notified to the School in writing.

2.I confirm that the student (mentioned above) is currently living within the home zone of Silverdale School and the residential address which I have provided to the School will be their usual place of residence when the School is open for instruction unless I notify the School otherwise in writing.

3.I understand that students accepted under the in-zone criteria are expected to remain resident in-zone for the duration of their enrolment with the School.

4.A temporary residence within the School’s home zone has not been used for the purposes of gaining enrolment at the School.

5.I will advise the School of any change of address. If any change involves a move from in-zone to out of zone I undertake that prior to the move being undertaken I will apply to the Board in writing and with reasons, for permission for the student to continue as a student at the School. Where permission is not given I acknowledge that the Board may review the student’s enrolment which may result in that enrolment being annulled.
I confirm that the information contained in this enrolment is true and correct in every respect.
Signed*
Date*
DD slash MM slash YYYY
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Student Details

Ethnicity

Parent/Caregiver Details (1)

Parent/Caregiver Details (2)

Emergency Contact (1) - alternative to parent/caregiver

Emergency Contact (2) - alternative to parent/caregiver

Health

Custody/Access Arrangements

Early Childhood Education

Documents

Additional Fields

Privacy & Policy

Signature

Enrolment Information for In Zone Students

Statutory Declaration for In-Zone Enrolments

Contact Us

Term Dates 2024