Enrolment Form

Student Details
Student's Name *

First Name Last Name
Student's Date of Birth *

Day Month Year
What year level are you enrolling for?
If Year 10 -13, the Dean for that year level will contact you to organise the Enrolment Interview. If year 9, please book an appointment using the link on the Enrolment Page of our website.
Student's current or most recently attended school *
Number of schools attended *
Has the student ever been excluded from another school? (if yes, this means the Enrolment Interview will be with the Principal).

Yes No
Student's personal email
example@example.com
Student's personal mobile number

Area Code Phone Number

Zoning Information
Students who live within the school zone are entitled to a place at Rutherford College.

To see if you live within our Enrolment Zone Map click here and enter ‘Rutherford College’ in the search box. You can also click on ‘address’ and enter your address in the search box.

The Rutherford College home zone shall be bounded by a line running from Huruhuru Creek along the centres of Triangle Road, Lincoln Road, Mt Lebanon Lane, the railway line, View Road, Gt. North Road and Hepburn Road to the corner of Akatea Road and thence directly ahead down the southern boundary of Hepburn Park to the Whau River, then north along the shoreline of Te Atatu Peninsula back to Triangle Road bridge over the HuruHuru Creek.

Out of Zone Enrolments
Please see our website for details of out-of-zone enrolment deadlines and information.
Type of application *

In Zone Out of Zone
Primary residence of student. *

Street Address

Street Address Line 2

City

Postal / Zip Code
Priority Selection (for Out of Zone applications) *

Does not apply as we are In Zone. First Priority: This priority category is not applicable at this school because the school does not run a special programme approved by the Secretary. Second Priority: will be given to applicants who are siblings of current students. Third Priority: will be given to applicants who are siblings of former students. Fourth Priority: will be given to any applicants who are a child of a former student of the school. Fifth Priority: will be given to any applicant who is either a child of an employee of the board of the school or a child of a member of the board of the school. Sixth Priority: will be given to all other applicants.
Does your child have a sibling currently attending Rutherford College? If yes, please write the name and tutor class of the sibling(s) currently attending. *
Does your child have a sibling that is a former student of Rutherford College? If yes, please write the name of the former student and the years they attended. *
Does your child have a parent that is a former student of Rutherford College? If yes, please write the name of the parent and the years they attended. *
Does your child have a parent that is a current employee or board member of Rutherford College? If yes, please write the parent's name. *
.

Student Profile
The student profile is to help us get to know your son or daughter and to ensure that their special needs and abilities are met at Rutherford College. The information provided will be used to help us identify strengths and any barriers to learning and will be made available to your son/daughter’s teachers. We really appreciate your input.

Thank you for taking the time to complete this form.
Does your son/daughter have any known special needs? (e.g. exceptional ability (gifted), learning or behavioural needs such as dyslexia, Asperger’s, Autism, ADHD, anxiety, language difficulties). If your child has had formal testing, may we please have a copy of the report (you can attach this below). *
What outside activities does your son/daughter participate in? (e.g. sport, church, cultural). *
What are your son/daughter’s special hobbies, talents or interests? Please include any awards, or levels of achievement. *
What are your son/daughter’s special hobbies, talents or interests? Please include any awards, or levels of achievement. *
Please comment on your son/daughter’s relationships with others and their ability to cope with stress/ change/disappointment. *
Please add any other information that may help us to support you and your son or daughter at school. *
If you have documents relating to your child's learning needs, please upload them here, they will be given to our SENCO.

Browse Files

Cancel of

Devices For Learning (D4L)
Rutherford College encourages students to bring their own device to school to connect to the internet and carry out classroom activities digitally. Teachers use Google Classrooms and online learning sites to engage and support students academically. It is strongly recommended that all students have a device.

While the school does not require a specific device, a Chromebook has proved to be an economic and serviceable option as the platform for learning resources in use is Google Classroom.

Minimum specifications required
Keyboard
2 USB Ports
10" Screen
Minimum 6 hr Battery Life
4GB Memory
Audio Out
ACD Power Adapter/charger
Lightweight
WiFi

Operating Systems
Windows 7 or higher or Mac 10.6 (Leopard) or higher

Antivirus Software
Web Browser (Google Chrome capable)
Software that enables word processing, presentations, spread-sheets, image manipulation, video and audio editing (these can be cloud-based - eg Google Docs). The Ministry of Education provides Office 365 free to students to install and use both at college and home.

Additional Equipment likely to be required
USB Pen Drive
Headphones

Things to consider if purchasing a device:
iPads do not have the ability to connect to external devices such as a mouse, USB, or hard disk
Increased memory will result in smoother running devices
2 or 3 year warranties are recommended, especially if they include replacement batteries
Ensure your household/contents policy will cover your son/daughter's device
Will your child have a device they can bring to school every day? *

Yes No
If the school has to move to Distance Learning (students learning from home) due to school closure (i.e if the COVID Alert Level is raised) does your child have daily access to a device? *

Yes No
Will your child have the ability to connect to the internet from their home? *

Yes No

Parent/ Caregiver's Declaration
Prefix *

Miss Mrs Mr Dr
Parent/ Caregiver's Name *

First Name Last Name
Parent/ Caregiver's Email *
example@example.com
Parent/ Caregiver's Phone Number *

Area Code Phone Number
I First Name* Last Name* declare that all the information I have provided is true and correct, and I understand that giving false or misleading information is a criminal offence.
Signature *

Clear
Date *

Day Month Year
Date
Should be Empty:

	Yes	No	Not sure
Hepatitis B
Diphtheria
Measles, Mumps, Rubella (MMR)
Poliomyelitis (Oral)
Tetanus
Meningitis
H.P.V

	Yes	No
Asthma
Diabetes
Allergies (please specify)
ADHD/ ADD
Epilepsy
Migraines
Past Head Injury
Hepatitis B
Rheumatic Fever

Student Details

Zoning Information

Student Profile

Devices For Learning (D4L)

Health Record

Parent/ Caregiver's Declaration