Enrolment – Birkdale North School

Student Details
Legal Surname*
Preferred surname if different from above
Legal First Names*
Preferred first name if different from above
Date of Birth
Gender*
- Male
- Female
Address (where the child lives more than 50% of the time)*
Street Address Address Line 2 Suburb City Postal Code
Home Phone
Mobile Phone
Email (Parent/Caregiver)*
Pre-School Attended
Hours per week
OR Previous School Attended
Date first started school
Current school year level

Medical Information
Family Doctor*
Phone*
Before School Check
- Yes
- No
Medical Conditions (Including Sight/Speech/Hearing)
Medication Requirements
Allergies
Learning and Behaviour
Please let us know of any identified learning difficulties
Is your child receiving assistance from outside agencies
Other information/requests
Siblings
Name of siblings currently attending
Please include their full name and year level
Name of siblings who may attend in the future
Please include their full name and date of birth
Preferred Learning Pathway
Please choose your child's preferred learning pathway*
- English Medium
- French Medium
- Maori Medium
Absence or General Notification Contact
Email
Phone

Declaration
I understand the information on this form is collected to form part of the essential information the school holds on my child. This information is shared with the MOE and held on a national data base. I understand the information provided will be used for school based activities and be passed onto other agencies who work with the school for educational and health purposes. I understand my childs records will be passed onto subsequent schools.
Consent
- I give permission for my child to attend all approved educational visits and trips.
- I give permission for my child's photo to be used for promotional purposes, eg. website, newsletter.
- I agree to abide by all Board of Trustees policies
- I give permission for the school to act on our behalf in a medical emergency.
Date*
Please enter your name as a form of digital signature*
I confirm that the information provided in this form is true and correct. I have read and understood the declaration
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Student Details