Emergency  Details & Permissions From

EMERGENCY DETAILS

This must be completed, along with the Health Profile, by all adult and student participants in school activities and events, to comply with school health and safety requirements, and to enable the school to ensure that optimal staffing levels are provided, the specific needs of participants are met, and the educational value and safety of school activities and events are maximised.

Date of Birth *

Emergency Contact Details

Please provide at least two sets of contact details below that are not already covered on the Family part of this form.

Date *

HEALTH PROFILE

Please choose all that your child suffers from

Migraine Epilepsy Asthma Diabetes Travel Sickness Fits of any kind Chronic Nose Bleeds Heart Condition Dizzy Spells Colour Blindness Other - Specify below.

Is your child currently taking medication? If Yes please fill out the next set of 4 questions *

Yes No

Is your child allergic to any of the following? Please specify and state the treatment.  Please put N/A if not relevant. (The form will not send if you do not do this)

When was your child's last tetanus injection?

Is there any information the staff should know to ensure the physical and emotional safety of your child? (For example, cultural practices, disability, anxiety about heights/darkness/small spaces, behaviour or emotional problems) *

Yes No

Please tick the following where applicable:

I agree that if prescribed medication needs to be adminstered, a designated adult will be assigned to do this. I will ensure the medication is clearly labelled, securely fastened and handed to the designated adult with instructions on its administration.

Yes

I will inform the school as soon as possible of any changes in the medical condition or other circumstances during the year.

Yes

I agree to my child receiving any emergency medical, dental, or surgical treatment, including anesthesia or blood transfusion, as considered necessary by the medical authorities present.

Yes

Any medical costs not covered by ACC or a Community Service Card will be paid by me.

Yes

To be read and signed by a legal guardian.

Date signed *

PERMISSION FORM

I give permission for my child's work to be used in school publications, understanding that the newsletter is placed on the website. This may include the class blog where the students first names only will be used. This could occasionally include a local newspaper.

Yes No

I give permission for my child's photo to be used in school publications. This may include our website, Facebook or a local newspaper. *

Yes No

I give permission for my child to be videoed; this may be used on the class blog or website or may be used by teachers for their professional development.

Yes No

Medical Emergencies

I give permission for school staff to act on my behalf in the event of a medical emergency where the school staff are unable to contact me or any of the emergency contacts I have given for my child. I will pay any associated costs of the emergency treatment.

Yes

Date Signed *

PERMISSION TO PICK UP STUDENTS

This is permission for the named people to pick up the following students.

The following people are authorised to pick up the above-named students

Date Signed *

Thank you to Tairangi School and Whaea Rona for this Kawa of Care which we have adapted to suit our school

Our Commitment to Pay Attendance Dues

This enrolment document is a legal contract between the New Zealand Seventh-day Adventist Schools Association Limited as the Proprietor and the Person(s) Accepting Responsibility for the Payment of Attendance Dues.

Family Details

As the person(s) enrolling the student(s), I (we) accept responsibilty for the payment of all dues, and have read and accept the conditions of enrolment as set out in the next section of this form.

Yes

Date Signed *

Date Signed *

Account Payer's Details

I agree to pay the attendance dues for students on this form for the full duration of their enrolment at the Wellington Seventh-day Adventist School.

Yes

Date Signed *

Student Details

Kindly provide the details of all students in your family who are currently enrolled at Seventh-day Adventist Schools in New Zealand.

With this list please provide each students Legal Surname, Legal Given Name(s) (place preferred name in brakets), their year level, Date started and School Code (see below for these codes)

My Payment Plan Agreement Form

Purpose of this Application

By electing to enrol your child in an Adventist school and filling in this form, you are committing to making regular payments towards Attendance Dues. This application is aimed at creating a reasonable, workable schedule for the payment of the Attendance Dues which are your legal obligation.

***Please ensure that you complete all questions below***

Account Details

I commit to pay (see payment Plan Guidelines below)

Tick only one and then fill in the amount you commit to pay. *

Weekly Fortnightly Monthly Per Term

Payment will be made by: (Choose one method of payment) *

Processing Direct Debit or Automatic Banking Regular Cash Payments to the school Electronic payment to the Proprietor

Date of First Payment *

Date Signed *

Enrolment in the school cannot be confirmed until this signed form has been received by the school.

Payment Plan Guideline

Enrolment Pack Information

Documentation Requirements for New Entrants / Year 1 Students

Please also provide copies of the following.

If you are unable to attach copies here then you will need to bring them in to the school office.

Birth Certificate

Passport Copy

Visas (if applicable)

Immunisation records

• Enrolment Information Form
• Conditions of Enrolment
• Preference Determination Questionnaire
• Commitment to Pay Attendance Dues (CTP Form)
• Payment Plan Application
• Emergency Details
• Health Profile
• Permission Form
• Student Internet and ICT Safety Use Agreement
• Permission for student pickups

Any questions regarding the forms or information we have provided in the pack, please do not hesitate to contact the office on 04 2376282 or email office@wellingtonsda.school.nz

Thank you

• Student and Family - Update Contact Details - maybe included for new Sibling enrolments

*extra forms requred for multiple enrolments