Enrolments

Te Kura Kaupapa Māori Ō Piripono Te Kura Whakahou Ki Ōtara Enrolment Form

Please ensure that ALL sections are filled in correctly - if a question is no needing an answer then you must put n/a - the form may not send if you do not do this.

There is at least one emergency contact (preferably x2)

Valid Birth Certificate or Passport is provided.

Mana Kids (Nurse) form is done.

Immunisation Certificate.

Kohanga Reo or Previous Kura report.

STUDENT INFORMATION

Child's Date of Birth *

Child's Gender *

Male Female

Tamaiti Pepeha

Please upload the Tamaiti Pepeha you downloaded and filled out at the start of this process *

Parents/Guardians

Make sure to inform Kura of any change of details as these will be used to contact you
Email is recommended – To receive emails regarding child and kura panui etc.

Main Parent/Caregiver

Gender *

Male Female

Support Parent/Caregiver

Gender *

Male Female

Emergency Contact Information

Emergency Contact One

Emergency Contact Two

Adults Forbidden by Law to Have Access to Your Child

(Please complete the following if there is any person(s) NOT permitted any access to your child at Kura )

Court Papers Provided

Previous Education

Current Health Information / History

(Any medical history/information please record i.e.: asthma, bronchitis etc. )

Has the child completed their immunizations? *

Yes No

Copy of Immunization Record

Asthma *

Mild Average High Risk N/A

Blanket Consent

This EOTC form is to cover events which occur during a school day and con-clude prior to approximately 3pm. Where an event involves risk exposure greater than what would be at Kura such as activities or hazardous environ-ments or the event continues overnight, specific consent will be required. Pri-vacy Statement: The personal information collected on this form is for the pur-pose of running EOTC events. No information will be disclosed for any other purpose except in accordance with the Privacy Act 1993 *

Yes No

First Aid Consent

I give my consent to the Kura to obtain such medical assistance as may be neces-sary when I cannot be contacted. I agree to meet any cost incurred for the treat-ment or transportation of my child to receive medical attention. *

Yes No

Pain Relief Consent

I give consent to administer pain relief or other medication listed, if required *

Yes No

Vision & Hearing

I give consent for my tamaiti to undergo vision and hearing testing *

Yes No

Nurse/ Dentist Consent

I give consent for my tamaiti to be seen by the Kura nurse, Dental nurse. *

Yes No

Internet Usage Consent

I give consent for my tamaiti to be given access at Kura to computers, the inter-net, and other communication technologies. *

Yes No

Photo Usage Consent

I give consent for my tamaiti photos to be taken whilst participating in Kura ac-tivities that may be used in Kura panui etc. *

Yes No

Emergency Contact Consent

I give consent for my tamaiti to be taken to an emergency contact location should the need arise. *

Yes No

EOTC Consent

I give consent for my tamaiti to be taken for walks, activities etc. outside Kura grounds within the local area. *

Yes No

Responsibility Consent

I understand that nga kaitiaki will be responsible for my tamaiti only during li-censed hours (8:30am – 3:30pm) and that they will be released only to author-ized persons *

Yes No

Whanau Support

All whanau have skills that can benefit our Tamariki and our Kura.

Which committee would you prefer/ be interested in?

Property/Resources Finance Assets Fundraising Health & Safety Policies

Parent/Caregiver signing

Checking the box below is equal to you signing this section of this form

Parent/caregiver Signing

Signed

Privacy Act

The information collected will be used for the purpose of completing Government documentation and for your child’s well-being while at Kura. Child observations will be carried out for the purpose of curriculum planning. The child’s individual files will always be available to whanau. I consent to the use of information for the purposes outlined above

Parent/Caregiver signing

Checking the box below is equal to you signing this section of this form

Parent/Caregiver signing

Yes