APPLICATION FORM – Ongata Royal

Child's Information

First and Middle Name*

Last Name*

Class/Grade*

Residential Address 1*

Residential Address 2

Town / City

Postcode

NEMIS Number

KNEC Assessment Number

Mother's Information

First Name*

Last Name*

ID Number*

Phone*

Email*

Occupation*

Place of Work

Employer Address

Office Phone

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Father's Information

First Name*

Last Name*

ID Number*

Email*

Phone*

Occupation*

Place of Work

Employer Address

Office Phone

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Guardian's Information

First Name

Last Name

ID Number

Phone

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Medical Information

Special Dietary Requirements, Food Allergies or Intolerances

Child's Medical Alert

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Pediatrician's Name

Pediatrician's Phone Number

Insurance Company

Policy Number

Emergency Contact Information

Emergency Contact Name

Emergency Contact Number

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Consent

Permissions*

I have read and accepted the schools terms and policies.

I agree to my child using school transport (liability waiver)

I understand that the school cannot be held liable for any unfortunate illness or injuries sustained by our child while under the care of the school.

Photography & Video Consent

Yes, I Consent for my child to be photographed & recorded, and photos/video to be displayed

No, I Do Not Consent

How did you hear about us?

Additional Information

I will complete and return the following on admission:

Completed application form
Birth certificate (photocopy)
NEMIS Number
KNEC Assessment Number (Grade 3 and above)
Assessment book from previous school
All medical and special care information.
Childs immunization/clinic card (Playgroup to PP2).