[FrontPage Save Results Component]

Child Information:

Admission Date:            Family Name:

DOB/Verified:               Forenames:  

Gender:             Female Male                             Caregiver:     

Caregiver Status: Dual Parent Solo Parent Solo Father Solo Mother De Facto Guardian Other

Mother Information:

Name:       

Address:    

Occupation:

Phone:       

Father Information:

Name:       

Address:    

Occupation:

Phone:       

Doctor:

Medical Problems:

Emergency Number and Contact    Emergency Number and Contact

   

Place in Family:                  

Language Spoken at Home:

Ethnicity:                           

Country of Origin:             

Date of Arrival in NZ:       

 

Year:   

Room:

Original School:

Date 1st Started at School:

Last School Attended:

Address:

Date Left:

Preschool Attended:

 

Others in Family:

Eldest in School:

No. of Siblings:                      DOB

Sibling Name:  

Sibling Name:  

Sibling Name:  

Iwi:

You may enter more than one iwi.

Please enter "don't know" if you do not know.

Iwi:                      

Rohe (home area):

Iwi:                      

Rohe (home area):

Iwi:                      

Rohe (home area):

Other Information:

Approval to request pupil records from previous/to send on to the next school.

Signature:

Date: