Electronic Enrolment Form

Student Details

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1

2

3

4

5

6

7

8

Student Enthnicity

NZ Pākehā

Māori

Pacific Peoples

Australian

Asian

Middle Eastern/Latin American/African

North America

Europe/UK

Other-please complete below

Select from the options

Yes

No

Previous Early Childhood Education and Primary Schooling

Yes.

Not regularly, only occasionally with no ongoing schedule.

No, did not attend early childhood education.

Did not attend.

Kohanga Reo.

Playcentre.

Kindergarten or Education and Care Centre

Home Based Service.

Playgroup.

Correspondence School

Attended but outside NZ.

Attended but do not know what type of service.

None

6 months

1 year

18 months

2 years

More than 2 years

None

1 to 5 hours

6 to 10 hours

11 to 15 hours

16 to 20 hours

More than 20 hours

Proposed Starting Date

Health

Custody and Court Order (If Applicable)

Not Applicable

No

Yes

English Language, Learning and Behaviour Needs (If Applicable)

Specialist Resourcing/Agencies (If Applicable)

Caregiver Details

Yes

No

Second Caregiver

Yes

No

Emergency Contacts

Siblings

Language(s)

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