Bishop Viard College - Application for Enrolment

Bishop Viard College - Application for Enrolment
STUDENT DETAILS
Applying to enter Year Level blank in 20 blank .
Name

First Name Middle Name
Last Name
Preferred Name
Birth Date

Month Day Year
Gender
Country of Birth
Country of Citizenship
New Zealand Born:

Yes (Please attach copy of New Zealand Birth Certificate)
Overseas Born:

Yes (Please attach copy of passport, permanent residency or citizenship)
If overseas born, date of arrival to New Zealand
Ethnicity:
If Maori, please indicate Iwi:
Languages spoken at home:
Present school:
RESIDENCE A/PRIMARY CAREGIVER DETAILS

Primary Caregiver 1:
Name: Mr/Mrs/Ms/Miss

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Home Phone Number
Please enter a valid phone number.
Work Phone Number

Area Code Phone Number
Cell Phone Number

Area Code Phone Number
Email
example@example.com
Relationship to student:
Occupation:
Primary Caregiver 2.
Name Mr/Mrs/Ms/Miss

First Name Last Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell phone
Please enter a valid phone number.
Email
example@example.com
Relationship to student:
Occupation:

RESIDENCE B/SECONDARY CAREGIVER DETAILS

(If required)
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Name:Mrs/Mr/Ms/Miss

First Name Last Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email
example@example.com
Relationship to student:
Occupation:
Caregiver 2 - Name:Mr/Mrs/Ms/Miss:

First Name Last Name
Home Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Cell Phone:
Please enter a valid phone number.
Email
example@example.com
Relationship to student:
Occupation:

EMERGENCY CONTACT DETAILS
Name

First Name Last Name
Relationship to student:
Phone Number

Area Code Phone Number
Emergency Contact 2
Name

First Name Last Name
Relationship to student:
Phone Number

Area Code Phone Number
MEDICAL DETAILS:
Name of Doctor:
Phone Number

Area Code Phone Number
Does your son/daughter have any medical conditions that we should know about? If yes, please specify:
Does you son/daughter take/carry any regular medication? If yes, please specify:
Does you son/daughter have a physical condition or learning disability that might affect classroom learning, eg hearing loss, need for glasses, motor skill loss, dyslexia, etc? If yes, please explain:
Do you agree to your son/daughter receiving panadol or other non-prescription medication if considered neccessary?

Yes No
Do you want your child to under-take the free Health and Wellbeing assessment which includes medical treatment, medication, health promotion and education by the School Health Practitioner/Nurse (it is confidential and will not be discussed with anyone else unless there are issues of safety or if there are medical concerns?

Yes No
SPECIAL INTERESTS:

Please list any interests, sports or activities in which you child may be involved:
Hobbies/Interests:
Sporting:
Cultural:
Other:
RELIGION AT THE COLLEGE:
Students religion:
Has your child received the following sacraments in the Catholic Church?

Baptism Reconciliation Holy Communion Confirmation
Parish Attending:
Please list the names and years of attendance of any IMMEDIATE family members who attend or have attended Bishop Viard College:
Please list the names of any siblings that are likely to attend in the future, and their current year level:

AGREEMENTS:

Caregiver agreement to condition of enrolment:
- The student will participate in the Religious Education program and actively support the Special Character of the college, including reconciliation, masses and class retreats. I/We agree to support our child in the faith of the Catholic Church.
- I/We agree to help my child follow the school rules and expectations.
- I/We agree that any photgraphs taken while participating in school acitivites can be used for school promotional purposes.
CYBERSAFETY AGREEMENT (CAREGIVERS)
I/We have read this Cybersafety Use Agreement and understand that my child is responsible for using communications technologies and accessing the internet at school as outlined here. I also understand this agreement applies to communication technologies my child brings into the school environment.
CYBERSAFETY AGREEMENT (STUDENTS)
I understand and will follow the conditions and rules set out in the school's Cybersafety Use agreement.
By filling in this form you are agreeing to all of the agreements above:

Yes, I agree to all statements above
Should be Empty:

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Bishop Viard College - Application for Enrolment

RESIDENCE A/PRIMARY CAREGIVER DETAILS

RESIDENCE B/SECONDARY CAREGIVER DETAILS

EMERGENCY CONTACT DETAILS

MEDICAL DETAILS:

SPECIAL INTERESTS:

RELIGION AT THE COLLEGE:

AGREEMENTS:

CYBERSAFETY AGREEMENT (CAREGIVERS)

CYBERSAFETY AGREEMENT (STUDENTS)