Online Enrolment Form (IN ZONE ONLY)

Kia ora! Welcome to Cockle Bay School. ** Year 1 Kea & 2 Tui Musical Instrument Making Show Monday 29th July at CBS **

Student Details
Student's Name*
First Last
Student's Preferred Name
First Last
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
- Other
If "Other", please specify*
Type of Enrolment*
- In Zone
- Out of Zone
Student lives with: Both Parents/Caregivers*
- Yes
- No
If no, please specifiy who Student lives with
Current Year Level

Optional
Current School or Kindergarten*
Home Address*
Street Address Address Line 2 Suburb City Post Code
Siblings
Siblings currently attending Cockle Bay School
Ethnicity
Iwi/Hapu
Affiliation
Ethnic Group/s*
Language Spoken at Home*
Country of Birth*
Country
Nationality*
Country
Date of Entry*
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 Suburb City Post Code
Occupation*
Workplace*
Email*
Home Phone
Work Phone
Mobile Phone*
Ethnic Background*
- NZ European
- NZ Māori
- Other
Please state Iwi*
If other, please state ethnic background*
Language(s) spoken*
Country of Birth*
Country
Country of Citizenship*
- NZ Citizen
- Permanent Resident
- Student/Work Visa
Date of Entry to NZ*
MM slash DD slash YYYY
Visa Expiry Date*
MM slash DD slash YYYY
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 Suburb City Post Code
Occupation
Workplace
Email
Home Phone
Work Phone
Mobile Phone
Ethnic Background*
- NZ European
- NZ Māori
- Other
Please state Iwi*
If other, please state ethnic background*
Language(s) spoken*
Country of Birth*
Country
Country of Citizenship*
- NZ Citizen
- Permanent Resident
- Student/Work Visa
Date of Entry to NZ*
MM slash DD slash YYYY
Visa Expiry Date*
MM slash DD slash YYYY
Emergency Contact (1) (other than a parent)
Name*
Prefix First Last
Relationship to Student*
Home Phone
Mobile Phone*
Emergency Contact (2) (other than a parent)
Name
Prefix First Last
Relationship to Student
Home Phone
Mobile Phone
Health
Allergies
Medication
Hearing
Vision
Speech
Other Health Issues
Special Learning and Behavioural Needs
Has your child received any of the following?
- ORS - Ongoing Resources Scheme
- SLT - Speech Language Therapy
- ELL - English Language Learning
- ICS - In Class Support
- Other
If other, please specify details*
Fully Immunized*
- Yes
- No
Consent
In an emergency, I give permisson for Cockle Bay School to call an ambulance or transport my child by private vehicle to the nearest Accident & Emergency if they have been unable to notify myself or emergency contacts
Medical Centre Name
Doctor's Name
Phone
Custody/Access Arrangements
Do both parents have legal access to student?*
- Yes
- No
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 regularly attend Early Childhood Education?*
'Regularly attend' means the child was booked in to a service for sessions each week/fortnight, and generally went to those sessions unless they were sick, or on holiday, or had a family occasion, etc.
- Yes
- Not Regularly, only occasionally with no on-going schedule
- No, did not attend ECE
- Attended but outside New Zealand
If Yes, for how many years?*
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 Centre
- 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 Centre*
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 Te Aho Te Kura Pounamu*
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.
Tenancy Declaration*
Please attached either Home Owners/Occupiers or Rental, Lease or Tenancy or Boarders or Multiple Occupancy Declaration (Form available on Enrolment Page).
Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.
Student's Birth Certificate/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.
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.
Privacy & Policy
Permissions
- I give permission for my child's photograph/work to appear in publications including, but not limited to, online digital and print media related to school activities. I give permission for my child's first and full last names to appear in the School Yearbook.
Privacy Statement
In terms of the Privacy Act, I understand that the information in this form is essential information the school holds on my child. I approve the forwarding of information when my child transfers to another school, including name and address on request to a potential Intermediate School and also my telephone number and address to be made available to the Parent Teacher Network (PTN) and Board of Trustees (BOT) as required. I will do my best to ensure that my child complies with School Regulations and Policies. I understand that the school will take action on my behalf in case of sudden illness or injury.
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
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Online Enrolment Form (IN ZONE ONLY)

Student Details

Siblings

Ethnicity

Parent/Caregiver Details (1)

Parent/Caregiver Details (2)

Emergency Contact (1) (other than a parent)

Emergency Contact (2) (other than a parent)

Health

Custody/Access Arrangements

Early Childhood Education

Documents

Privacy & Policy

Signature

Contact

Quick Links

2024 Term Dates