Title DR MISS MR MRS MS TRUE First Name * Last Name * Email Address * Name of kindergarten for enrolment -- Please select -- Adventure Ascot Park Bellevue Berhampore Betty Montford Brian Webb Brooklyn Cambridge Street Campbell Churton Park Discovery East Harbour Hataitai Island Bay Kura Pepe Island Bay Kura Tamaiti Isola Pre Entry Group Johnsonville Johnsonville West Karori Katoa Khandallah Lyall Bay Maraeroa Mataitangi Community Kindergarten Miramar Central Miramar North Moira Gallagher Mungavin Newlands Newtown Ngahina Ngaio Northland Nuanua Kindergarten Onslow Otaki Owhiro Bay Papakowhai Paparangi Paraparaumu Paremata Parsons Avenue Petone Petone Beach Pikopiko Clyde Quay Plimmerton Pukerua Bay Pukerua Bay Pre-School Raumati Beach Raumati South Seatoun Strathmore Park Sunshine Tairangi Taitoko Tawa Central Titahi Bay Tui Park Wadestown Waikanae Waitangirua Wellington South Who can collect your child? Your child’s safety is important to us - only the people you name below will be allowed to collect your child from the kindergarten. If someone else is collecting your child, you must let the teachers know. Parents don’t need Alternate people who can collect your child: Person 1, Name Alternate people who can collect your child: Person 1, Address Alternate people who can collect your child: Person 1, Phone numbers Alternate people who can collect your child: Person 1, Relationship to child (e.g. caregiver/nanny/uncle) Alternate people who can collect your child: Person 2, Relationship to child (e.g. caregiver/nanny/uncle) Alternate people who can collect your child: Person 3, Relationship to child (e.g. caregiver/nanny/uncle) Alternate people who can collect your child: Person 2, Name Alternate people who can collect your child: Person 2, Address Alternate people who can collect your child: Person 2, Phone numbers Alternate people who can collect your child: Person 3, Name Alternate people who can collect your child: Person 3, Address Alternate people who can collect your child: Person 3, Phone numbers Emergency Contacts: It is very important that you fill in this section. This is for medical or civil defence emergencies. These people should not be your child’s main caregivers, and if possible they should live nearby. Emergency Contact Person 1, Name * Emergency Contact Person 2, Name Emergency Contact Person 3, Name Emergency Contact Person 1, Phone numbers * Emergency Contact Person 2, Phone numbers Emergency Contact Person 3, Phone numbers Emergency Contact Person 1, Relationship to child * Emergency Contact Person 2, Relationship to child Emergency Contact Person 3, Relationship to child Names of people who are forbidden by law to have access to your child or who have right of access subject to conditions. You will need to give us a copy of the relevant legal documentation (Access/Protection Orders) confirming this. Medical information: Name of child's doctor and/or medical centre: Medical information: Phone number of child's doctor and/or medical centre: Child’s Medical Information: (eg Allergies, asthma. You may need to fill in another form.) Name any specialist care your child is involved in or receiving (eg grommets, paediatrician) Family/Whānau Information: (This information is required by the Ministry of Education for statistical purposes) Ethnic Group/ Nationality of child: (you may give more than one) * If NZ Maori, please enter their iwi: (you may give more than one) Languages spoken at home: * Religion: Parent Occupation(s): Have you any skills or resources that you can share with the Kindergarten? Which school is your child likely to attend? Does your child attend any other Early Childhood Service (eg crèche, childcare)? * Which days and hours does he/she attend that service? (If your child is attending another ECE service, you must talk with one of the Kindergarten Teachers about this.) DECLARATION OF UNDERSTANDING I give permission for teachers to apply basic first aid, sunscreen, and insect repellent products to my child and change her/his wet or soiled clothing when necessary. * I give permission for teachers to obtain medical treatment for my child in an emergency and I accept responsibility for the expenses incurred. * I give permission for my child to have their ears and vision tested/examined as part of the Ministry of Health screening programme and agree that my contact details may be passed on for any further follow up work to the tests. * I give permission for my child to be photographed or videoed as part of the kindergarten’s documentation of learning. * I give permission for my child to use ICT equipment to support their early childhood education. * I understand that my child’s portfolio will be accessible to my child and my family. I confirm that I will respect the confidentiality of other children’s documentation. * I give permission for samples of my child’s work to be used in displays at the kindergarten or in the community. * I give permission for photographs/video of my child to be used for publicity purposes. * I give permission for my child to go on short walks with the teacher/s in the area around the kindergarten. * I understand that I will be required to give written consent for any excursion in which my child is required to travel by motor vehicle. * I understand that my child may be taken to an alternative location during an emergency. This might be a local civil defence centre or another safe place. * I understand that teachers are responsible for my child only during session times and that I am responsible for seeing my child gets safely to and from Kindergarten. * I have read the sleep policy and seen the sleeping rest facilities ( this does not apply in sessional Kindergartens). 20 HOURS ECE DETAILS: Click Yes to confirm you understand the '20 hours ECE' and if your child takes part, your child does not receive more than 20 hours of the Government’s ‘20 hours ECE’ per week across all services. * I understand that Families who are not using all or any of their 20 Hours ECE at kindergarten will be asked to pay a fee for each hour that is not attested for the Government’s 20 Hours ECE rate. * I have read the Wellington Kindergartens Fees policy and agree to pay any fees resulting from my child’s enrolment at kindergarten as per this policy (a copy of the Fees Policy is available in your Whānau folder). * I elect to pay fees on the following basis: *
