New Zealand School Enrolment Form

Henderson Intermediate School
Enrolment Form

Office Use Only

Start Date

Year

Enrolment Number

Student NSN

Zone

Room, House Colour, Spec Group

Please complete the following to begin the online enrolment process.

Prior to your child starting, you will need to come into school to complete the process. Please bring with you:

• A copy of your child's Birth Certificate or Passport

• Proof of current address

If you have digital copies of these, please upload here:

Browse Files

Please select the Year you are enrolling your child for.

Student Information

Last Name

First Name/s

Birth Date

DayMonthYear

Gender

Address

Street Address

Street Address Line 2

Post Code

Mobile

Home Number

Ethnicity

Iwi (If applicable)

Language/s spoken at home

Country of Birth

Date of Entry to NZ if born overseas:

Date

NZ Citizen?

If no, please provide VISA number, type, issue and expiry.

Siblings currently or previously at H.I.S?

If yes, please list name/s.

Previous School

Please list the names of other students you would like your child placed with. We won't be able to fulfil all requests but will do our best.

Parent/Caregiver 1 Details
Please state your address below if different from student's

First Name

Last Name

Relationship to student

Work Number

Mobile Number

Address (If different from student's)

Street Address

Street Address Line 2

Post Code

Email

example@example.com

Parent/Caregiver 2 Details
Please state your address below if different from student's

First Name

Last Name

Relationship to student

Work Number

Mobile Number

Address (If different from student's)

Street Address

Street Address Line 2

Post Code

Email

example@example.com

Emergency Contact 1

First Name

Last Name

Relationship to student

Work Number

Mobile Number

Address (If different from student's)

Street Address

Street Address Line 2

Post Code

Emergency Contact 2

First Name

Last Name

Relationship to student

Work Number

Mobile Number

Address (If different from student's)

Street Address

Street Address Line 2

Post Code

Medical

Doctor's Name

Medical Practice

Phone Number

Please list any of the following: Current medications, Medication allergies, Food allergies, Chronic health concerns.

Do you give permission for Panadol to be given to your child if needed?

Te Whānau Moko - Māori Bilingual
Please complete if you wish to apply for these classes, otherwise please move onto the next section.

I am applying for

Has your child previously been enrolled in a bilingual, rumaki or kura kaupapa?

If yes, where and for how long?

Reo Māori Proficiency

Do you speak Te Reo Māori at home?

Does your child have someone to support them in their reo Māori outside of school?

Please note, all applications to Te Whānau Moko will be reviewed and an interview organised with the student, whānau, Team Leader and Staff.

Tupu ma Ola - Samoan Bilingual Application
Please complete if you wish to apply for this class, otherwise please move onto the next section.

Samoan Language Proficiency

Do you speak Samoan at home?

Does your child have someone to support them in their Samoan Language outside of school?

Authorisations

DECLARATION:
I apply to enrol my child at Henderson Intermediate School and agree to abide by the expectations of the school.
I will provide the school with documentation relating to my child’s birth date, immigration status and proof of permanent residential address if
requested.

MEDIA/INTERNET

I authorise Henderson Intermediate School to publish images of “my child” on the Internet and / or other computer created media, as well as any work
that he / she may create at school.
I agree that this consent shall continue until I withdraw my consent by notice to the school.

WALKING PERMISSION

During the year our students have various trips and curriculum activities that involve walking to and from different venues.
To ensure that your child is able to participate in these activities, we require permission for them to leave the school grounds.

Signed

Date

Please inform the office of any other vital information you think they may need to know in the event of an emergency or specific custody arrangements we need to be aware of. Thank you.

Please note, you will need to come into School prior to your child starting to sign authorisations and permissions and also to bring the documents mentioned above.