Enrolment Form - Don Buck Primary School

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Don Buck Primary School Enrolment Form

This form will take approximately 15 minutes to complete. If you do not have time to complete the form in one sitting there is a 'Save and Continue' button at the bottom providing a link for you to complete the form within 30 days. In addition to this form, the following documents are required by the school office:

Birth Certificate if born in NZ or Passport if born overseas

Immunisation Certificate

2x Proof of Residence

Any documentation pertaining to custody restrictions

Please make an appointment by calling the school office on 09 833 6005.
Student Details
Name*
First Last
Preferred First Name and Surname
Date of Birth*
Gender*
- Male
- Female
Address*
Street Address Address Line 2 City ZIP / Postal Code
Previous School
Year Level at Previous School
Parent / Caregiver 1 Details
Name*
First Last
Title*
- Mrs
- Ms
- Miss
- Mr
Legal Guardian?*
- Yes
- No
Relationship to Child*
- Mother
- Father
- Aunt
- Uncle
- Grandmother
- Grandfather
Address*
Street Address Address Line 2 City ZIP / Postal Code
Home Phone
Mobile Phone*
Work Phone
Occupation*
Email*
Workplace
Parent / Caregiver 2 Details
Name*
First Last
Title*
- Mrs
- Ms
- Miss
- Mr
Legal Guardian?*
- Yes
- No
Relationship to Child*
- Mother
- Father
- Aunt
- Uncle
- Grandmother
- Grandfather
Home Phone
Mobile Phone*
Work Phone
Occupation*
Email*
Workplace
Emergency Contact Details
Please indicate which of these contacts will be able to pick your child up by car if we cannot contact you.
Emergency Contact 1
Name*
First Last
Phone*
Relationship to Child*
- Aunt
- Uncle
- Grandparent
- Family Friend
Emergency Contact 2
Name*
First Last
Phone*
Relationship to Child*
- Aunt
- Uncle
- Grandparent
- Family Friend
Ethnicity Information
ETHNIC GROUP/S: Please tick appropriate boxes (up to three)
Ethnicity*
- Māori
- NZ European
- Samoan
- Tongan
- Cook Island Maori
- Other
You responded Māori, please indicate your iwi(s)*
You responded 'Other', please specify*
Country of Birth, if other than New Zealand
Home Language
Time lived in New Zealand (e.g. 1 year 4 months)
Date of Arrival in NZ
Mother's Country of Birth
Father's Country of Birth
Prior Participation in Early Childhood Education
The below Early Childhood Education information is a requirement as directed from the Ministry of Education.
Was ECE regularly attended?*
- Yes
- Not regularly, only occasionally or with no ongoing schedule
- No, did not attend ECE
How many years did the child attend ECE for?*
Please enter the services attended (up to 3)*
- Kohanga Reo
- Playcentre
- Kindergarten or Education and Care Centre
- Home based service
- Playgroup
- Correspondence School – Te Aho o Te Kura Pounamu
- Attended, but only outside New Zealand
- Attended, but don’t know what type of service
- Did not attend
- Unable to establish if attended or not
How many hours attended per week for each service?*
Did your child attend one or more Early childhood Education service(s) in the six months prior to starting school?*
- Yes
- No
Custody / Access Restrictions
Please provide the necessary documentation to the school office
Briefly outline any issues that you feel we should be aware of
(WE RECOMMEND THAT YOU SPEAK TO THE PRINCIPAL and/or TEACHER ABOUT ANY ISSUES THAT MAY BE A CONCERN)
Medical Information
Asthma
- Mild
- Moderate
- Severe
Eczema
- Mild
- Moderate
- Severe
Epilepsy
- Mild
- Moderate
- Severe
Bladder
- Mild
- Moderate
- Severe
Nose Bleeds
- Mild
- Moderate
- Severe
Bee Stings
- Mild
- Moderate
- Severe
Speech
- Mild
- Moderate
- Severe
Hearing
- Mild
- Moderate
- Severe
Vision
- Mild
- Moderate
- Severe
Other (e.g. allergic to peanuts), please indicate severity
Medication: Please note details if your child requires medication at school
I consent to my child’s vision and hearing being tested*
- Yes
- No
OK for school to administer PANADOL tablets if necessary*
- Yes
- No
Doctor's Details and Phone Number*
Learning / Behaviour Needs
Please state any special learning, ability or behaviour needs your child may have:
Parent / Caregiver Agreement
- I have completed all relevant sections of the enrolment form and the information supplied is correct.
- I have supplied or will supply copies of documentation where applicable (i.e. Birth Certificate, Passport, Immunisation Certificate)
- My child will be attending school regularly.
- My child will abide by the School Policies.
- My child will wear the correct Don Buck Primary School uniform.
- I give permission for my child’s records to be obtained from their previous school.
- I understand and accept that school records containing information about my child may be shared with education and/or health officials, and will be forwarded on to the next school my child attends.
- Along with all staff at Don Buck School, our Community Constable, our Public Health Nurse and our SWiS (Social Worker in Schools), will be involved in your child’s care and well being while they attend our school.
If you do not wish your child/ren to access this important pastoral caring please indicate
- No
I give permission to include my child’s work, image or name in school newsletters and/or school website*
- Yes
- No
I give permission for my child to have milk on Monday through to Thursday mornings*
- Yes
- No
I understand that the information stated on this form is true and correct and agree to be part of the learning process of my child. Name of Parent/Caregiver in lieu of signature:*
Members of your family likely to be attending this school in the future, please provide names and birth dates
Internet Users Policy
The use of the Internet at Don Buck Primary School is a privilege not a right.

The Internet is made available to students under the following conditions.

The Internet use shall be for the purpose of:

Providing information for students such that they may have a better understanding of subject matter.

This application to use the internet is signed by the relevant caregivers. The policy statement and a code of conduct will form the basis of the documentation that the caregiver and students agree to. When the school has the signed application, the child/ren will then use the Internet under adult supervision.

Internet User Policy - Code of Conduct

The following code of conduct will be adhered to by all those using the School’s Internet connection.

Guideline 1 : General statement
The Internet is provided for the education of and the improved delivery of curriculum material.

Guideline 2 : Use of service
- No profanity, obscenities or any other language that could be construed as such, is to be used in any Email messages.
- No private information is to be distributed to other parties at any time. This includes reposting of information sent by another party.
- The network is not to be used by any student for personal gain or illegal activity.
- Deliberate attempts to gain access to any site containing inappropriate material will be dealt with by the management of the school.
- All copyright, privacy and international laws are to be abided by at all times.
- At no time will people place orders for goods or services over the Internet using the school name, title or funds.
- The downloading of material from the Internet is not to be attempted. People may speak to the ICT team about anything they want downloaded and the site will be checked to ensure appropriateness.
- Any deliberate attempt to spread viruses through the network will be dealt with by the management of the school.
Guideline 3: Liability
- Don Buck School is not and cannot be held responsible for the loss of material, accidental corruption or any other action that might affect transmission or loss of data.
- Don Buck School has taken all possible precautions to maintain safety of all users and these guidelines are written and enforced in the interest of all Internet users’ safety and effective use of the Internet.
APPLICATION FOR AN INTERNET LICENSE
Name of Student*
As the parent/guardian/caregiver of the student identified above I have read the Policy Statement relating to the use of the Internet in the school and I understand that the intention of the use of the Internet within the school is for educational purposes. I understand that Don Buck School has taken all possible precautions to make the Internet as safe as possible for all users. I also agree to support the school in any action it may take to ensure that the code of conduct, as described in the Policy Statement, is followed.
Parent / Caregiver name in lieu of signature*

Save and Continue Later

Contact Details

09 833 6005
office@donbuck.school.nz
124 Don Buck Road
Massey
Auckland 0614
New Zealand

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