2021 Student Enrolment Form

Student Enrolment Form

STUDENT DETAILS
Application Type

In-Zone Out-of-Zone
In-Zone Enrolments Only:
Attach as proof of In-Zone Residence - a recent copy of one of the following: electricity or telephone account, or tenancy agreement. Enrolments cannot be accepted without this. We DO NOT accept Rates/Environment Waikato
invoices or Sale and Purchase Agreements.
Please upload document with proof of address for In-Zone enrolments

Upload Proof of Address
This can be a power bill, telephone account or tenancy agreement. Cancel of
Legal Surname
Legal First Name/s
Preferred Surname
Preferred First Name/s
Address

Street Address

Street Address Line 2

City

Postal / Zip Code
Phone Number

Area Code Phone Number
Gender
Date of Birth

Day Month Year
Current Class/Year Level
Previous School
Date Intending to Start CMS?

Day Month Year
Date
Previous School Address

Street Address

Street Address Line 2

City

Postal / Zip Code Country
Ethnicity
Please type up to three Ethnicities
Iwi/Hapu
Please type up to three Iwi/Hapu
Country of Birth

Street Address

Street Address Line 2
Copy of NZ Birth Certificate or NZ Passport must be attached. Eligibility to study in NZ - Student Visa or NZ Residency documentation must be provided.

Browse Files

Cancel of
Home Language
Bus Route
Residency/Citizenship

Yes No
If No / Date of NZ Entry

Day Month Year

Student Enrolment Form

Parent/Caregiver Details 1
Name

Title First Name Legal Surname
Relationship to Student
Address if different from Student

Street Address

Street Address Line 2

City

Postal / Zip Code
Occupation
Workplace Hours
Phone Home

Area Code Phone Number
Phone Work

Area Code Phone Number
Mobile

Area Code Phone Number
Country of Birth

Street Address

Street Address Line 2
E-mail
Bill Payer

Yes No
Notice Recipient

Yes No
Parent/Caregiver Details 2
Name

Title First Name Legal Surname
Relationship to Student
Address if different from Student

Street Address

Street Address Line 2

City

Postal / Zip Code
Occupation
Workplace Hours
Phone Home

Area Code Phone Number
Phone Work

Area Code Phone Number
Mobile

Area Code Phone Number
E-mail
Country of Birth

Street Address

Street Address Line 2
Bill Payer

Yes No
Notice Recipient

Yes No

Student Enrolment Form

Emergency Contacts
Name 1

First Name Last Name
Relationship to Student
Phone Home

Area Code Phone Number
Mobile

Area Code Phone Number
Name 2

First Name Last Name
Relationship to Student
Phone Home

Area Code Phone Number
Mobile

Area Code Phone Number
Name of Legal Guardian/s
Name of Bill Payer
Name and Age of Siblings Living with the Student

CyberSafety Use Agreement Form
To the parent/caregiver/legal guardian, please:
1. Read this page carefully to check that you understand your responsibilities under this agreement.
2. Sign the appropriate section on this form.
I understand that Cambridge Middle School will:
- Do its best to enhance learning through the safe use of technology. This includes working to restrict access to inappropriate, illegal or harmful material on the internet or devices at school, or at school-related activities.
- Work progressively with children and their families to encourage and develop an understanding of the importance of cybersafety through education designed to complement and support the Use Agreement initiative. This includes providing children with strategies to keep themselves safe in cyberspace.
- Keep a copy of this signed Use Agreement on file.
- Respond to any breaches in an appropriate manner.
- Welcome enquiries from parents/caregivers or students about cybersafety issues.
My responsibilities include:
- I will read this Cybersafety Use Agreement document.
- I will discuss the information with my child and explain why it is important to make appropriate choices.
- I will support the school’s cybersafety programme by encouraging my child to follow the cybersafety rules, and to always ask the teacher if they are unsure about any use of technology.
- I will contact the principal or school cybersafety manager to discuss any questions I might have about cybersafety and/or this Use Agreement and I am welcome to do this at any time.
I give permission for images of my child to be published on the school website, our school facebook page and class apps.The purpose of the publishing is to celebrate student work and communicate with our school community.

Yes No
I have read the CYBERSAFETY USE AGREEMENT and I am aware of the school’s initiatives to maintain a cybersafe learning environment, including both mine and my child’s responsibilities particularly around the choices we make.

Yes No
Students Name

First Name Last Name
Student's Signature

Clear
Name of Parent/Caregiver/Legal Guardian

First Name Last Name
Parent/Caregiver/Legal Guardian Signature

Clear
Date

Day Month Year
Date
Please note: This agreement for your child will remain in force as long as he/she is enrolled at this school. If it becomes necessary to add/amend any information or rule, parents/caregivers/legal guardian will be advised in writing.

Personalised Medical Action Plan
Name

First Name Last Name
Room Number
Medical Condition
Name of medication to be issued
Treatment required
E.g., My child reacts to bee stings by severe swelling to the area. Has been to the Doctor for treatment but never hospitalised. Medication is two antihistamine tablets immediately. Get to a Doctor if the swelling does not go down.
Any know allergies
(include what allergy, symptoms of reaction and severity)
Parent/caregiver name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Mobile

Area Code Phone Number
Work

Area Code Phone Number
Someone will usually be home on the following days

Monday Tuesday Wednesday Thursday Friday
IN AN EMERGENCY AND WE CAN NOT CONTACT YOU-WHO IS THE NEXT PORT OF CALL:
Name

First Name Last Name
Relationship to Child
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number

Area Code Phone Number
Mobile

Area Code Phone Number
Work

Area Code Phone Number
Family Doctor
Doctors Phone Number

Area Code Phone Number
I give permission for the medication described above to be administered if and when necessary by the staff of Cambridge Middle School. NO medication will be given unless it has a pharmaceutical label with the child’s name, clear dosages, the name of the drug, expiry date (if applicable) and where it is to be stored i.e. fridge. In the event of an accident or sudden illness, I authorise the staff of Cambridge Middle School to obtain medical emergency assistance as necessary. Although all due care will be taken by CMS staff, the school is relying on accurate and up to date information if we are to assist in an emergency situation.

Yes No
Parent/Caregiver Signature

Clear
Date

Day Month Year
Date
NB: This Authority requires to be renewed yearly or will end at the completion of the course of medication being issued.

In-Zone Approval: I confirm that the address I have provided to the school will be the usual place of residence for my child when school is open for instruction. I will advise the school of any subsequent change of address. Should I subsequently move outside the CMS Zone, I understand the Board of Trustees has the right to review the enrolment and withdraw the offer of placement. Consequences will also occur if a false or temporary address is knowingly given and if the school learns that a student is no longer living at the in-zone address after attendance has begun. Unless a satisfactory explanation is given, the BOT may annul the enrolment under Section 110A of the Education Act 1989. (Applicable to in-zone enrolments only.)
Out-of-Zone (tick which of these priorities apply)

You have a sibling who is a current student You have a sibling who is a former student You are the son/daughter of a former student You are the son/daughter of an employee of the Board of Trustees or Board of Trustees Member You have no prior or current association with Cambridge Middle School
Privacy Approval: The school will use any information collected about you, your child or other members of your family for enrolment, educational,
data-gathering and analysis, and health purposes, and to ensure compliance with relevant laws (the Purpose). Any information held by the school that relates to you or your child may be viewed on request at the school. The information collected may be disclosed to education, health and welfare authorities (including, by way of example, the Ministry of Education (MOE) and the Ministry of Social Development (MSD)) for the Purpose. The school will ensure that information is gathered and used in accordance with the principles of the Privacy Act and the Health Information Privacy Code. You give permission for images of your child to be published on the school website to celebrate student work and communicate with our school community. You agree to the collection and use of information and images in the manner described in this statement.
Parent/Caregiver Approval - I agree: That I have completed the Cambridge Middle School Health Consent form; to abide by the school’s rules and policies; that my child’s work and image may be used in accordance with the school’s online publishing policy/procedures; that I have read, understood and agree to the Privacy Approval; that I have read, understood and agree to the Cyber Safe Consent and the provisions of the Use Agreement; that all information I have provided in this Enrolment Form and the Health Consent Form is true and correct; that the school may forward my child’s name and address to potential immediate, middle and secondary schools; and that I have read, understood and agree to the following: I agree that my child will require a school Gmail account (as detailed in the information in the BYOD form), I have understood the information relating to GAFE and the rules that apply to my child’s use of that account, consent to the opening of that account and approve the monitoring of and access to it by the school.
Signature

Clear
Parents Full Name

First Name Last Name
Date

Month Day Year
Should be Empty:

Student Enrolment Form

Student Enrolment Form

Parent/Caregiver Details 2

Student Enrolment Form

Student Enrolment Form

Health

CyberSafety Use Agreement Form

Personalised Medical Action Plan