Microsoft word - enrolment application form.doc

Northcote College Application for Enrolment
GENERAL INFORMATION
Year of Entry:
(please select 1-4 as applicable)
STUDENT DETAILS
Family Name:
Ethnicity (you may choose up to 3) NZ European (please specify)……………………………………………… (please specify)………………………………………………. (please specify) ………………………………………….………… Iwi 1: ………………………………. (please specify) ………………………………….……….… (please specify) ……………………………………………… Iwi 2: ………………………………. (please specify) …………………………………………………………… (please specify) …………………………………………………….……. Iwi 3: ………………………………. Name/s of Siblings at Northcote College: Previous 2 Schools & Years attended: Family links to Northcote College (siblings, parents or grandparents are past pupils, former staff – please provide years if known): PARENT/CAREGIVER DETAILS
Title: (please circle)
Other Caregiver
Relationship (if not mother/father) Address (if different from student) If student does not live with both parents does the second parent require copies of correspondence and reports? Yes No Application for Enrolment at Northcote College EMERGENCY CONTACT (NOT PARENT OR CAREGIVER)
Family Name (Mr/Mrs/Ms/Miss/Dr)
ELIGIBILITY FOR STUDY IN NEW ZEALAND
Entry Status:
Passport Number: ………………………………………. Country of Issue: ……………………………………. Immigration Client No.: ……………………………… Arrival date in NZ: …………………………………. Student Visa Expiry Date: ……………………………. Passport Expiry Date: ……………………………… Passport Number: ………………………………………. Country of Issue: ……………………………………. Immigration Client No.: ……………………………… Arrival date in NZ: …………………………………. Work Permit Expiry Date: ……………………………. Passport Expiry Date: ……………………………… HEALTH INFORMATION
1. Existing Medical Conditions
Please specify details of condition, severity and medication (eg Ventolin, Ritalin): Please provide detailed information of condition, severity of reaction and medication (eg antihistamine, EPI pen) Panadol: I give permission for the school nurse/school staff to administer paracetamol Blood Borne Viruses: Parents are required to disclose information related to a student’s health at time of enrolment or subsequent infection. SPECIAL NEEDS/ASSISTANCE
My child has had previous [delete one]
My child has had previous involvement with the following support support/extension in the following areas: services (please tick as applicable): Other (please specify) ______________________________ My child has specific learning needs / abilities: Please specify: ……………………………………………………………………………………………………………………………………… ……………………………………………………………………………….…………………………………………………………………… ……………………………………………………………………………….…………………………………………………………………… Please note: All Year 9 students are required to undertake pre-entry testing in Mathematics and Reasoning Skills. STUDENT INTERESTS eg Sports, Musical Instrument, Performing Arts etc (please be specific, including level
and achievement to date)
Application for Enrolment at Northcote College Please state your reasons for choosing Northcote College: _____________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Students from another NZ secondary school:
Upon acceptance for enrolment students and parents/caregivers of transferring students to Northcote College must complete the Northcote College Sports Statutory Declaration Form and a Premier Transfer Form. Please note: Northcote College is bound by the ASSHA Sports Bylaws. The reason for these bylaws is to eliminate ‘poaching of players’ between schools. It is important that enrolling students understand the bylaws when transferring between schools. Bylaws 10.8.1 through to 10.8.9 set out the regulations for transfer of students from one school to another, with respect to their eligibility of playing in Premier Sports Teams [a full set of bylaws is available on www.collegesport.co.nz].
Declaration:
 I hereby make application to enrol my son/daughter at Northcote College.
 I agree that he/she will be subject to school rules and I will endeavour to see that he/she obeys them
 I understand that the school will take action on my behalf in case of injury or sudden illness and agree to meet all  I understand that if enrolled my child may be involved in walking off the school campus under the jurisdiction of  I understand that if enrolled my child may also be involved in regular extra curricular sports and cultural activities outside school hours and may require transport with another parent, coach or manager.  This information is provided on the understanding that it is only for use by the College or for statistical purposes. I understand that the school may retain this information indefinitely. This information will be held securely in the school archives. I give my permission for information about my son/daughter held at his/her previous school(s) to be transferred to Northcote College. I have read the Privacy Act information attached to this application (Appendix 2).  I confirm that the information given in this application is correct and complete and I understand and accept that Northcote College may actively seek to verify this information. Name (please print clearly): ______________________________________ Student Signature: __________________________ Checklist for information to be provided with this application:
Copy of NZ Birth Certificate or Passport showing current residence/work permit status (refer Eligibility for Other supporting documentation (optional) please specify ________________________________________________ In-Zone Applications Only:

TWO original documents as proof of residence within the Northcote College School Zone (please note at least one must be an electricity account, a telephone account or tenancy agreement). Application for Enrolment at Northcote College Northcote College School Rules
Student Appearance and Dress
The rules apply to students in any of the following situations
a. Uniform/dress regulations must be obeyed (see Uniform/Dress information over). a. while at College
b. on the way to or from College
c. All uniform/dress must be tidy, clean and in good repair. c. if the student is attending any College organised function such as a sports trip, school camp
d. The only jewellery permitted is a watch and one small plain stud worn in each ear. Facial or school sports match
d. if the student is known to belong to the College or is recognised as a College student
e. if the incident in which the student is involved is likely to bring the school into disrepute.
Hair styles must not be extreme in cut or colour. Plain navy blue or black headbands may be This includes a student recognised as a College student in the company of another College
student who is actively bringing the school into disrepute.
g. Make-up and nail polish should be minimal and not detract from the school uniform. Attitude to Others
Motor Vehicles, Cycles and Traffic Rules
a. Students must be courteous and show respect in their dealings with all members of staff. a. Every student who wishes to use a car or motorcycle for transport to and from College is b. Disruptive behaviour in class which interferes with the learning of other students and the required to request permission from the Assistant Principal by completing the appropriate teaching by staff will not be tolerated. form giving details of the vehicle and of their NZ licence. A window sticker will be required to c. Physical violence, sexual harassment, bullying and/or verbal abuse will not be tolerated. show that permission has been granted. No vehicles may be brought to school unless a sticker Public Image
b. Students are not permitted to carry other students to and from the College in cars or on a. Correct uniform/dress must be worn at all times on the way to and from school and on formal motorcycles unless written agreement has been received from the parents of both the driver school occasions eg sports prizegiving and open evenings. and passengers and written permission has been given by the Assistant Principal. This b. Caps and other head wear must not be worn inside school buildings. permission is only given where special circumstances apply. c. Students must show respect and be courteous in their dealings with all members of the public. c. The Road Code will be strictly observed at all times. No student vehicle is to be parked in the d. Students must abide by fair play rules when playing sport. e. Students must wear correct and complete sports uniforms when playing sport for Northcote d. Vehicle and lunchtime passes may not be held concurrently. e. Students crossing Onewa Road must cross on a pedestrian crossing. Attitude to Property
Attendance
a. Students must arrive by 8.55am and be in class by 9.00am. tag, graffiti or in any other way damage buildings, furniture or equipment b. Students arriving late for school at any time must sign in at the Dean’s office. have at school spray cans or wide felt tip pens c. Students must attend all timetabled classes while at school unless otherwise directed by a staff walk on gardens or damage trees or shrubs d. No students may leave the grounds during College hours without permission from parents or b. Fire alarms must not be touched except in cases of emergency. an appointment card. Students obtain a yellow exit slip from the Dean’s office. Students c. Skateboarding is not permitted in the school grounds at a any time. returning from an appointment before the end of the school day must sign in at the Dean’s
Smoking, Drinking, Drugs and Weapons
e. Students wishing to leave the grounds at lunchtime must bring a letter from home. A lunch a. Smoking and the possession of smoking equipment is forbidden. pass may be issued at the discretion of the Deputy Principal. b. Possession and/or consumption of alcoholic liquor is forbidden. c. Drug usage and possession for use other than for commonly accepted medical reasons is Students who become sick at College must report immediately to the nurse (on-site 10am-2.30pm) or the d. Sniffing of solvents or products containing volatile solvents or their possession is forbidden. Dean’s Office and must not leave the College without permission. Appropriate arrangements will be e. Substances or articles that are likely to be harmful (matches, fireworks, offensive weapons, made to care for the student or for collection by parents. knives etc.) must not be brought to College. If there is a suspicion that a student has broken any of the above rules the school reserves the right Breach of School Rules
A breach of school rules will lead to a consequence appropriate to the offence. The most serious consequences are a stand down, suspension, exclusion or expulsion from the school. a. Students will not enter classrooms in the absence of a teacher, unless authorised by a b. The hall foyer may not be used by students unless accompanying visitors. c. The vicinity of construction work and all workers equipment is out of bounds. d. The following areas are out of bounds: School hall, stage and understage (except where directed by a staff member).  Black leather shoes (refer 3&4 below)  Black or tan belt Beyond the buildings on the Kauri Glen Road fence line (except during class time when  Plain navy blue or plain black scarf  Plain v-neck school polypropylene vest (undergarment) Uniform Regulations
Swimming pool enclosure (except with teacher supervision). 1. Trousers must fit properly. Skirts must not be shortened or altered. Bottom field (unless actively participating in a sport under teacher supervision). 2. Garments must not be overlarge for the student. Tennis/netball courts (unless actively participating in a sport). 3. No boots, sports shoes (eg Globes) or sports boots are to be worn. 4. Traditional black polishable leather lace up school shoes are required with uniform.
5. Items of clothing that are not listed above may not be worn as part of the uniform. 6. The uniform is to be worn at school, to and from school and at all school functions. 7. PE – a change of clothes must be worn for all P.E. classes. The PE uniform is to be worn by all Main school entrance (except when moving in or out of the school). junior students in 2009. Shorts and a T-shirt suitable for the purpose must be worn at all other levels (refer also to Year 13 dress code). Personal Property
8. Plain black socks (must not go above the knee) or black stockings must be worn with black leather a. Valuable items should not be brought to school. No responsibility is taken by the school for NB: In Terms 1 and 4 students may wear black roman sandals without socks but shoes with a full b. Students must not take or use the property of another student. heel and toe must be worn in any laboratory or workshop. c. Any damage to College property must be reported immediately to a member of the staff. 9. All uniform items must be clean, tidy and neither torn nor frayed. d. Chewing gum is not allowed at Northcote College. 10. No T-shirts are to be visible under uniforms. e. Reading material which is unduly racist, sexual, sexist or violent must not be brought to 11. Jerseys are to be worn as an outer garment. (Shirts must not show below the jersey) 12. Stockings must not be worn with shorts. The school diary is compulsory for Years 9-11. An acceptable diary is compulsory for Years 14. Only Northcote College jackets may be worn with school uniform. The Gold & Blue Northcote g. Cell phones, MP3 players and other personal entertainment systems are permitted at school College uniform jacket is currently being phased out. but must be switched off and out of sight during school hours. School phones are available 15. No beanies are to be worn at any time. for use in an emergency. Urgent personal cellphone messages may be checked at the office without penalty during interval and lunchtime. Year 13 Dress Code:
Uniform regulations relating to hair and jewellery apply to year 13 [refer to student appearance and Uniform/Dress
The uniform will be worn by students in Years 9, 10, 11 and 12. Parents and students may select items from the following list. All items are mix-n-match. Uniform is purchased from Yarnton’s, Birkenhead. The College Shop is open Monday - Thursday from 10am to 1.30pm during term time for the purchase of stationery items, second-hand uniforms garments with offensive material on them (when available) and sports team uniforms. garments advertising alcohol, cigarettes, drugs ii) Suitable footwear must be worn. Jandals are not acceptable for safety reasons. Pale blue button through woven fabric shirt (short or long sleeve) Families who have difficulties in meeting any of the above requirements are expected to Appendix 2
Appendix 2
NORTHCOTE COLLEGE
Privacy Information
We are required under Principle 3 of the Privacy Act 1993 to inform you: That we are collecting this information as a basis for your child’s school records. That this information will be available to the Principal and designated staff of Northcote College.
A. Information Provided by You or your Child
You have been asked to provide Northcote College with personal information about your child and yourself or family. Your child’s file is confidential but you have: i. The right to access the personal information you supplied The right to ask us to correct any of the personal information you supplied.
B. Information Provided by Others
You may be requested to authorise the school to collect information (verbal or written) from persons nominated by you. The school will not contact these persons without your express prior consent. Communications between these persons and the school is strictly confidential. The information provided by these persons will not be disclosed to you.
C. Information Created by the School
In the course of your child’s education, information will be generated by the Principal and her agents. For example: i. Evaluations and assessments prepared by various Government Departments (Education, Social Welfare, Health) and private agencies (eg private education providers). Records of the above type will at all times be the property of Northcote College and any information generated by the school will only be disclosed to you at the discretion of the Principal or nominated agent.

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