Online Enrolment Form

Southland Boys High School - 2010 Enrolment Form

Section A: Personal Information
Family Name
First Name(s)
Preferred Name (if different from first name)
Date of Birth
Age
Year level student will enter at SBHS
Date to commence study at SBHS?
Does the student have any brothers at SBHS?	Yes No
If yes, list the names of brothers attending SBHS and their level. Name Year Level
Boarding
At Coldstream House Yes No	Application Made? Yes No
Private Board With
Name
Address
Phone
Lunch Arrangements	At School At Home
Transport to school eg: Cycle, bus, walking, car. If bus, give route name and company:
Section B: Background Information
Ethnicities
Tick your ethnic group(s) - you may tick up to three groups
NZ European/Pakeha NZ Maori Cook Island Maori Samoan Tongan Niuean Tokelauan Fijian Southeast Asian Chinese Indian other European other Pacific Island other Asian other Please Specify
Specify Other Details
If you are a NZ Maori, to which iwi do you belong?
Are you a New Zealand resident?	Yes No
If not, country of Birth Date of Arrival in New Zealand Note: Please attach a copy of your visa/permit
Section C: Contact Information
Details of parent(s)/caregiver(s) living at student's permanent address
First parent/caregiver
Family Name
First Name(s)
Relationship to student
Occupation
Home Phone
Work Phone
Mobile
Email Address
Second parent/caregiver
Family Name
First Name(s)
Relationship to student
Occupation
Home Phone
Work Phone
Mobile
Email Address
This will be the address we use for school communications.
Student's permanent address details
Street Address	Number and Street Name/ Rapid Number and Road Name, Suburb name / Rural Delivery Number, Town / City/ Area / Country
Postal Address (if different)
Student's Email Address
Student's Mobile
Section D: Contact Information Continued
If there is a second parent/caregiver who does not live at the student's permanent address, please give their details here.
Family Name
First Name(s)
Relationship to student
Occupation
Street Address	Number and Street Name/ Rapid Number and Road Name, Suburb name / Rural Delivery Number, Town / City/ Area / Country
Postal Address (if different)
Home Phone
Work Phone
Mobile
Email Address
Section E: Emergency Contact Other than parents or caregivers
Family Name
First Name(s)
Relationship to student
Occupation
Home Phone
Work Phone
Mobile
Section F: Student Background Other than parents or caregivers
Special Education
Has the student been verified as an ORRS student (tick the applicable box)?	Very high needs High needs Declined on application
Does the student have teacher aide assistance?	Yes No
If yes, state the number of hours per day
Medical Information
Name of Family Doctor
Medical matters the school should know about, eg: Asthma, prescribed medication etc.
Is your son on any medication to modify his behaviour?	Yes No
If yes, provide details
Student Profile
Current School
Year Level
School Achievements (list any academic, sporting, musical or other achievements)
Behaviour
Has your son been sent home, stood down or suspended? Yes No
Provide Details
Student's interests, hobbies, sports, career plans
Section G: Declaration Please note The information provided here is important for our records. If at any time there are changes, such as a change of address, the school needs to be informed. A telephone call to the office is all that is required. Your co-operation will be appreciated. The school reserves the right you use, where required, private information for educational, administrative and marketing purposes.
We agree that our son obeys the rules and regulations of Southland Boys' High School.

It is agreed that the student's name, address and date of birth may be passed to organisations associated with Southland Boys' High School, such as SBHS Rugby Club, SBHS Cricket Club, Parent Teacher Association,Old Boys' Association.
Student name	Date

We give permission for personal information to be used for educational, administrative and research purposes
We give permission for photographic images of our son and/or his work to be reproduced for marketing purposes
We give permission for paracetamol to be administered by first aid staff as and when required
We agree that our son will abide by the schools internet procedures
We agree that our son obeys the rules and regulations of Southland Boys High School
We agree to receive communication by electronic means
We further agree that the students name, address and date of birth may be passed to organisations associated with Southland Boys High School, such as SBHS Rugby Club, SBHS Cricket Club, Parent Teacher Association, Old Boys Association
File Attachments Please attach the following files in PDF format only (if applicable):
Copy of Birth Certificate
Copy of Visa (if appropriate)
Security Code	Enter the code in the field below: (the letters are case sensititve)

Online Enrolment Form

Southland Boys High School - 2010 Enrolment Form

Section A: Personal Information

Boarding

Section B: Background Information

Ethnicities

Section C: Contact Information

First parent/caregiver

Second parent/caregiver

Student's permanent address details

Section D: Contact Information Continued

Section E: Emergency Contact

Section F: Student Background

Special Education

Medical Information

Student Profile

Behaviour

Section G: Declaration

File Attachments