Kindergarten Application

Kindergarten Application
Child's details*

Official given nameMiddle namesOfficial surname or family name
Name your child is known by/ preferred name
Preferred name
Date of Birth*

DayMonthYear
Date
Gender

MaleFemale
Child's primary residential address*

Street Address

Suburb

CityPostal / Zip Code

Country
Child's secondary residential address (if applicable)

Street Address

Suburb

CityPostal / Zip Code

Country
Child's Background*
Ethnic Origins - Iwi belongs to - Languages spoken at home

Parents & Guardians
Parent / Guardian*

Given namesSurname/ family name
Relationship to child*
Phone*
Email*
Parent / Guardian*

Given namesSurname/ family name
Relationship to child*
Phone*
Email*
Custodial Statement
Are there any custodial arrangements concerning your child? If YES, please give details of any custodial arrangements or court orders (a copy of any court order is required) Include names of person(s) who CANNOT pick up your child.
Additional Emergency Contacts (also able to pick up child): *
Please list 2 different ones to above Parents / Guardians. Provide name, address, telephone number and e-mail.

Health
Doctor

Doctor's nameMedical centre
Phone
Illness / Allergies*
Immunisations*
Please provide verification of all immunisations
Details
Vision & Hearing Screening
I/we give permission for our child to take part in vision & hearing screenings
I have read the documents "Reducing food related choking for babies and young children at early learning services"

https://www.health.govt.nz/publications/reducing-food-related-choking-for-babies-and-young-children-at-early-learning-serviceshttps://www.health.govt.nz/system/files/2020-12/reducing-food-related-choking-babies-young-children-early-learning-services-apr21.pdf
A category (i) medicine is a non-prescription preparation (such as arnica cream, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the first aid cabinet.
Specific category (i) medicines that can be used on my child, provided by service:*

Calendula Cream (Weleda)Hypercal Cream (Weleda)Arnica Cream (Weleda)Herbal (calendula balm, kawakawa balm, handmade by staff)SunscreenBug spray
Parent/Guardian Signature - Please sign in person at the office
Date

DayMonthYear
Category (ii) medicines - Prescription (such as antibiotics, eye/ear drops etc) or non-prescription (such as paracetamol liquid, cough syrup etc) medicine that is used for a specific period of time to treat a specific condition or symptom, provided by a parent for the use of that child only or, in relation to Rongoa Māori (Māori plant medicines), that is prepared by other adults at the service.
I acknowledge that written authority from a parent is to be given at the beginning of each day a category (ii) medicine is to be administered, detailing what (name of medicine), how (method and dose), and when (time or specific symptoms/circumstances) medicine is to be given.
Parent/Guardian Signature - Please sign in person at the office
Date

DayMonthYear
Category (iii) Medicines - To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc and is for the use of that child only.
Medicine Details
Name of Medicine, Method & Dose, Time to be taken or Symptoms
Parent/Guardian Signature - Please sign in person at the office
Date

DayMonthYear

Fees/ Optional charges
Optional charges are a request for a payment that parents may choose whether or not to make for a specific expensense that are above what is required to meet the minimum regulated standards, such as high levels of staffing, organic food staples as part of the food preparation curriculum, additional natural first aid supplies, festivals and events etc. Please refer to the Parent Handbook for current fees.

I/we agree to pay the optional charges for the activities/items specified in this enrolment agreement form. Once an agreement to pay has been reached then services may enforce payment. Should there be reasons for financial difficulty, please arrange for an appointment with the General Manager to discuss.

I/we agree to pay the fees for all enrolled days even if my child is absent (e.g. unwell or on holiday).

I/we agree to give three weeks’ notice (or payment in lieu thereof) before withdrawing my/our child.

I/we agree to be responsible for any extra payment required for our child that has extra needs.

Statutory Holidays / Term Breaks: This enrolment agreement is exclusive of school term breaks and statutory holidays. The service is closed on statutory holidays and there is no charge for these days.
Parent/Guardian Signature - Please sign in person at the office
Date

DayMonthYear
Other information

Required Information for Licensing Purposes:
Excursions: I/we give permission for our child to take part in regular excursions in the immediate vicinity of the kindergarten, as per required supervision ratios.

Photo/video: I/we give permission for our child to be photographed for the purposes of assessment, planning and evaluation.

Photo/video: I/we give permission for our child to be photographed for the purposes of unnamed photos for kindergarten website and social media pages.

Policy Statement: Fossil Bay Kindergarten has a number of policies that set out the procedures that are in place for the care and education of the children who attend. The signing of this enrolment agreement form indicates that you will abide by the policies of this service, and understand how you can have input to policy review.

Texting: The kindergarten will occasionally send text messages to parents as a reminder of activities and to update in the event of civil emergency or unplanned closure of the service.

Privacy Statement:
Personal information about your child collected on this enrolment form is shared with the Ministry of Education who store it securely and treat it in accordance with the Privacy Act 2020. Information is disclosed to the Ministry:
• for funding allocation purposes
• for monitoring purposes
• to allow the assignment of a National Student Number* to your child, and
• to allow the Minister or Secretary of Education to exercise any of their other powers or responsibilities under the Education and Training Act 2020, and as permitted by Privacy Principles 10 and 11. Completed forms may also be viewed by Ministry officials on request for the purposes of monitoring and licensing.

* A National Student Number is a unique identifier for your child within the education system. You can find more information about National Student Numbers and what they are used for at National Student Number (NSN) » NZQA

Parent Handbook Book: Please ensure you have read the information in the Parent Handbook (available to download from our website) as it covers such things as the philosophy of our kindergarten, the fee details and ways in which we can help you and your child settle into the service.
Parent Declaration:*

I declare that all the above information is true and correct to the best of my knowledge.
Parent/Guardian Signature - Please sign in person at the office
Date

DayMonthYear

Fossil Bay Special Character Commitment
To confirm my child/ren’s enrolment at Fossil Bay and my commitment to supporting the delivery of a Steiner education, I confirm my relationship to and preference for the school’s special character and acknowledge the following:
- I understand that my child/ren will receive a Steiner education adapted by the College of Teachers to take into account the school’s place in the Aotearoa, its time context as a school in the 21st century, and its multicultural community built on the bi-cultural foundation of Aotearoa NZ.
- I commit to actively engaging with and striving to become informed about the culture and philosophy of the Fossil Bay School and while learning about it, to respect and uphold this Special Character.
- I undertake to support and uphold the school’s policy framework including protocols about communication, rules and guidelines and support my child/ren’s education by recognising the adverse developmental impact inherent in exposing children to the range of electronic media and cellular communication technologies.
I accept and will meet the following parent expectations:
- To attend class parent evenings (usually one per term) as well as teacher-parent interviews as scheduled or required, and in the event of being unable to attend, will submit an apology prior to the meeting/interview to the teacher.
- To develop and sustain positive relationships with all staff and members of the school community by engaging in positive and peaceful communication.
- To read the school newsletter and any class or office communications as a means of being informed about parent meetings and other important school events.
- To respond to requests regarding class activities (working bees, outings, etc)
- To support the school festivals.
- To participate in helping make fundraising initiatives a success.
Parent/Guardian Signature - Please sign in person at the office
Date

DayMonthYear

Please provide the following documents:
Please attach a copy of an official identity verification document:*

New Zealand birth certificateNew Zealand passportForeign birth certificateForeign passportOther
Attach File*

Browse Files

Cancelof
Service Declaration - To be completed by Fossil Bay General Manager

On behalf of Fossil Bay Kindergarten, I declare that this form has been checked and all relevant sections have been completed.
Fossil Bay Staff Signature:
Date

DayMonthYear
Should be Empty:

	Monday	Tuesday	Wednesday	Thursday	Friday	Total Hours
20 Hours ECE at this service
20 Hours ECE at another service

Kindergarten Application

Parents & Guardians

Health

Enrolment Details

Fees/ Optional charges

Other information

Fossil Bay Special Character Commitment

Please provide the following documents: