Online Enrolment Form for Local Students

Student's Details
Student's Last Name*
Student's First Name*
Date of Birth*

Day
Month
Year
Age last Birthday*
Country of Birth*
- New Zealand
- Outside of New Zealand
If not born in NZ, give date of arrival to NZ

Day
Month
Year
Gender*
- Male
- Female
Proposed date of entry to Al-Madinah School*
DD slash MM slash YYYY
Year Level*
Last school/kindergarten Name*
Last school/kindergarten Address*
Last school/kindergarten Phone Number*
Last school/kindergarten Fax
Names of sisters/brothers already attending Al – Madinah School
To add more than one sibling, please click on the + button to create extra rows
Brother's/Sister's Name Current Year Level
Immigration Status*
- 1. Citizen
- 2 Permanent Residence
- 3. Student Permit / Parents Work Visa
- 4. Tourist Visa
- 5. Other Visa

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Parent/Guardian's Details
Last Name*
First Name*
Home Address*
Street Address Suburb City ZIP / Postal Code
Phone Number*
Fax Number
Email Address*
Enter Email Confirm Email
Relationship to Student*

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Alternative Contacts
Contact Last Name*
Contact First Name*
Contact Address*
Street Address Suburb City ZIP / Postal Code
Contact Phone Number*
Relationship to Student*

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Medical
Family Doctor*
Contact Details for Doctor*
Dental Service*
Is your child registered with the Free Community Dental Service?
- Yes
- No
Learning Support*
Has your child been involved with specialist/resourcing or external agencies to support their needs?
- Yes
- No
If yes, further information is required below*
Please indicate any of your child's health needs
Select as many that apply
- Sight
- Speech
- Hearing
- Allergies

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Comments
Any further comments

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Parent's Documents
All of the document uploads below are required.

Accepted file formats: PDF, JPG, PNG
Maximum file size: 8mb
Parent's ID*
(Drivers Licence, etc)
Accepted file types: jpg, png, pdf, Max. file size: 64 MB.
Proof of Address*
Current Utility Bill (Power, Gas)
Accepted file types: jpg, png, pdf, Max. file size: 64 MB.
Proof of Immigration Status*
(Certificate of Citizenship copy or Passport copy with Visa/Photo Pages)
Accepted file types: jpg, png, pdf, Max. file size: 64 MB.
Child's Documents
All of the document uploads below are required.

For a New Zealand born child you can upload a Birth Certificate in both the Birth Certificate Section and Proof of Immigration Status section (as you cannot progress through to the last page of this form until both sections are completed).

Accepted file formats: PDF, JPG, PNG
Maximum file size: 8mb
Birth Certificate*

Accepted file types: jpg, png, pdf, Max. file size: 64 MB.
Proof of Immigration Status*
(Citizenship Certificate/NZ Birth Certificate or Current Visa/Photo pages from Passport)
Accepted file types: jpg, png, pdf, Max. file size: 64 MB.

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Declaration
Acceptance and Agreement*

Please read all information carefully before accepting.

Declaration
I understand that the decision to accept any student at Al–Madinah School is at the discretion of the Board of Trustees. I give my full assurance that I will pay the school fees in full, support the school and its special character and ensure that all the by-laws of Al-Madinah School are abided by the child whose application is being made. Furthermore I am aware that if fees are not paid in full on a timely manner than it will be handed to the debt collectors and the collection cost will be recovered by the debt collectors from me. I am also aware that the address and phone number details of my child/children are collected at the time of enrolment and during their time at school so that the school can contact the parent or student as necessary. These contact details may also be passed on to the Ministry of Education and the Ministry of Social Development (MSD). This is so, that young people who may have difficulty finding future employment; training or further education can be identified and offered support by organisations contracted by MSD to help re-engage young people in education or training when they leave school. In addition to the above I also give excursion permission for my child to participate in EOTC ((Education outside the Classroom) day trips throughout the year which includes cultural activities, religious, sporting, academic and curriculum related trips.

Privacy Act of 1993
Our school undertakes to collect, use and store information you provide on this form according to the principles of the Privacy Act 1993. The information will be used to complete forms required by the Ministry of Education, and the Education Review Office, and for administrative purposes within the school. I/We agree that this information can be used for the above purpose.
- Yes, I have read and understand this agreement, and accept and agree to all of its terms.
Parent / Guardian's Name*
Date*
DD slash MM slash YYYY
CAPTCHA

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Online Enrolment Form for Local Students

Required Documents

Parents

Child’s requirements

Step 1 of 7 - Student Details

Student's Details

Parent/Guardian's Details

Alternative Contacts

Medical

Comments

Parent's Documents

Child's Documents

Declaration

Brother's/Sister's Name	Current Year Level