Online Enrolment Please note maximum Total file size allowed on this form is 8 MB. Student DetailsEnrolment Type In Zone Out of Zone Student's Name* First Last Known As Date of Birth* DD slash MM slash YYYY Gender* Male Female Other If "Other", please specify* Current Year Level OptionalEldest Child at School OptionalCurrent School* Name of Primary School attended: Home Address* Street Address Address Line 2 City Suburb Post Code EthnicityIwi/Hapu Affiliation Ethnic Group/s* Language Spoken at Home* Country of Birth* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Nationality* AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Student Refugee Status/NZ Residency Status: Date of Entry to NZ* DD slash MM slash YYYY Parent/Caregiver Details (1)Name* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Refugee Status Primary Caregiver* Yes No Relationship to Student* Address* Same as Student Home Address Street Address Address Line 2 City Suburb Post Code Work Place (Company Name)* Email* Home PhoneWork PhoneMobile Phone*Parent/Caregiver Details (2)Name Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Refugee Status Primary Caregiver Yes No Relationship to Student Address Same as Student Home Address Street Address Address Line 2 City Suburb Post Code Work Place (Company Name) Email Home PhoneWork PhoneMobile PhoneEmergency Contact - Alternative to CaregiverName* Mr.Mrs.MissMs.Dr.Prof. Prefix First Last Relationship to Student* Home PhoneWork PhoneMobile Phone*HealthAllergies*Medication*Hearing*Vision*Speech*Other Health Issues*Special Learning and Behavioural Needs*Please write medication name(if held at school), Dosage, Frequency*Medical Center Name* Doctor's Name* Phone*The school may administer panadol for pain relief* Yes No I give permission for school staff to administer general first aid. I agree that the school will take action on my behalf in the event of a sudden medical emergency (illness or injury). Staff are not permitted to give any medication without consent.* Yes No Custody/Access ArrangementsCourt Order Issued* Yes No Court Order DocumentsAccepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Access ArrangementDocumentsProof of address*Council rates, water care, electricity bill etc.Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Student's Birth Certificate/Passport*If student is a New Zealand citizenAccepted 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.ICT Agreement form*(Signed by both Student and their parent/caregiver. This form can be found on the enrolment page of our website)Accepted file types: jpg, png, pdf, doc, docx, Max. file size: 8 MB.Additional FieldsPlease write siblings (who have attended in the past or will attend in the future) name & date of birthI give permission for my child’s name, image and school work to be displayed and published where appropriate e.g newsletter, school website, classroom displays, school promotion etc* Yes No Privacy & PolicyPermissions I have read and understood the privacy statement as below I give permission for Mt Roskill Intermediate School to share information on my child to their future potential intermediate or secondary school. I give permission for Mt Roskill Intermediate School to approach my child's current school to request information which could include academic, learning support and pastoral support. Privacy Statement The information collected on this enrolment application will be used by the school for enrolment purposes and forms an essential part of the information held by the school on your child. All information collected around your child's enrolment may be disclosed to appropriate education, health and welfare authorities and for data-gathering purposes by the New Zealand Ministry of Education, in accordance with the principles of the Privacy Act 2020. It will not be disclosed to any other person or agency unless such disclosure is authorised or required by law. Information collected may include academic, learning support and pastoral support. Privacy Act 2020 rights and obligations can be found at www.legislation.govt.nzSignatureBy 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 CAPTCHANameThis field is for validation purposes and should be left unchanged.