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E-Enrolment Form

Required Fields are marked with an asterisk (*)

Otamarakau School Enrolment Form

*First Names

*Family Name

*Date of Birth

*Gender

Male Female

*Country of Birth

*Residency Status

NZ Resident NZ Citizenship

Please check box that applys

Iwi Affiliations

If you class your child as Maori please detail any Iwi affiliations

*Ethnic Group Child Relates To

*Previous School/Pre School Centre & Address

*Current Year Level

*Proposed Starting Date

Please state when your child will start at Otamarakau School

Parent/Caregiver Details

*First Name

*Family Name

Title

Mrs Mr Ms Miss

*Relationship to Child

*Address

*Home Telephone Number

Work Telephone Number

Cell Phone Number

Email Address

Second Parent/Caregiver Details

*First Name

*Family Name

Title

Mrs Mr ms Miss

*Relationship To Child

*Address

*Home Telephone Number

Work Telephone Number

Cell Phone Number

Email Address

Custody/Access Arrangements

Details of Custody/Access Arrangements

Court Order Issued

Yes No N/A

Emergency Contacts

*Full Name

*Contact Phone Number

*Relationship To Child

*Full Name

*Contact Phone Number

*Relationship To Child

Health

Are there any health issues we should be aware of? ie allergies, medication, hearing or vision issues.

*Family Doctor

Please supply the school with your childs current immunisation certificate

Address

*Telephone Number

Additional Information

Learning & Behaviour Needs

Please supply any details of learning or behaviour needs