Liston College
Application For Enrolment at Liston College (New Zealand Residents)
A Year 7 to 13 College for Boys, offering a high quality education based on Catholic Values
Enrolment Application
Please complete all sections and return to Liston College. Please PRINT clearly.
All of the information collected in this Enrolment Form and during the student’s time at this school is CONFIDENTIAL and is covered by the Privacy Act 1993 and the Education Act 1989. This information, held at Liston College, 69 Rathgar Road, Henderson, is available to the Staff, Members of the Board of Trustees, PTFA, and the Liston College Old Boys Association ENTRY INFORMATION Year of Entry 20 ____ at year level 7 8 9 10 11 12 13
Application for: Preference / Non Preference (Please attach preference certificate if applicable)
PLEASE PRINT CLEARLY STUDENT’S DETAILS Family Name Preferred Name Home Address
Given Name(s) Home Phone
Current School Date of Birth / Date of Arrival in NZ (if not NZ Born) First Language(s) FAMILY DETAILS Child lives with: Both Parents
/ /
OR
/
Post Code: Current Year Level Country of Birth Permit (type) NZ Residency Permit No.
Mother
Father
Other
MOTHER’S DETAILS (Caregiver 1) or Relationship: ie Step-mother Family Name Given Name Home Address Phone (home) Phone (work) Mobile Occupation Email address
Title: Mrs/ Miss/Ms
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FATHER’S DETAILS (Caregiver 2) or Relationship: ie Step-father Family Name Given Name Home Address Phone (home) Phone (work) Mobile Occupation Email address
Title:
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PLEASE NOTE: In case of emergency Caregiver 1 will be contacted first.
EMERGENCY / ALTERNATIVE CONTACT (Other than parents / caregivers) Relationship Name: Mr / Mrs Phone (home) Phone (work) Mobile
PLACE IN FAMILY
____________out of __________ children
SIBLINGS AT LISTON: (Name) 1. 2. 3.
ELDEST AT LISTON
Yes
No
Year Level Year Level Year Level
Previous connection to Liston College (Parent, son of Old Boy, Edmund Rice/Christian Brothers Connection etc) Any family connection (past or present) with other Catholic Schools – Please give details
RELIGION Catholic Baptism Yes No Date of Baptism Catholic Sacraments (circle) First Holy Communion
Parish Reconciliation
Confirmation
GENERAL INFORMATION Please make a brief comment under each heading
SPECIAL STRENGTHS / INTERESTS Academic: (eg: Speech/Debating/Computing/Science/ Curriculum strengths)
Significant Awards Received:
Sport / Hobbies / Cultural Interests:
Personal Qualities:
SPECIFIC LEARNING NEEDS Academic Weaknesses: Learning and Behavioural Issues: (please outline any learning and behavioural issues your son may have)
ORS Funded
Psychological report available (Please attach)
STUDENT HEALTH Overall health:
MEDICAL CHECK LIST Family Doctor – Dr Medical Practice School Dental Service: Yes Has your child a medical issue?
Phone No Yes
No
Please tick if your child has any of the following Asthma Anaphylactic Diabetes Bee sting allergy ADHD / ADD Other allergies please specify
Inhaler required Epi-Pen required Insulin required Anti-histamines required Ritalin required
Permission to give your child Panadol if required: Yes No If yes: 1 tablet or 2 tablets
ETHNICITY DETAILS Nationality: (born in) ________________________________ First Home Language: __________________________ Ethnicity: African
Australian British / Irish Cambodian Chinese Cook Island Maori Dutch NZ European
Fijian Filipino German Indian Italian Japanese Korean Latin American
NZ Maori Middle Eastern Niue Polish Pacific Islands Samoan SE Asian Sri Lankan
South Slav Tokelauan Tongan Vietnamese Other Asian Other European Other Pacific People
Other: ________________________________
Refugee
Maori Tribal Affiliation (if applicable):_______________________________________
Permissions I / We agree to Liston College using photos / work of the above named student for marketing purposes. I / We give permission for Liston College to sanction any required emergency medical treatment. I / We give permission for my son to walk to Henderson Intermediate for school dental treatment if or when required.
Conditions of Enrolment
I / We agree to pay all Dues, Contributions, Sports and Subject Fees as determined from time to time by the Board of Trustees.
I / We undertake as a condition of enrolment and attendance, to pay Attendance Dues as determined from time to time by the Proprietor and approved by the Minister of Education. Furthermore, I / We accept that the school can discontinue attendance of the above named student in default of this undertaking.
I / We have disclosed all information concerning the above named student’s behaviour and learning needs. I / We agree that above named student will participate in the general school programme that gives Liston College its Special Character. I / We will ensure that above named student will wear the correct uniform and adhere to the Code of Conduct.
I / We understand that enrolment is subject to the availability of places within the prescribed allocation. Upon receipt of enrolment acceptance I / We agree to pay $250.00 deposit, of which $200.00 will be credited against the First Term Dues. The $50.00 balance is a non-refundable administration fee.
Mother / Caregiver 1: ______________________________ Father / Caregiver 2: ______________________________ (PLEASE PRINT)
Signed: Date: ______
(PLEASE PRINT)
______________________________
______________________________
__________
Quality Catholic Boys’ Education Printed 3/06/2015
In the Edmund Rice Tradition
Enrolment Checklist
CHECKLIST – Must be ticked off Please take the time to TICK OFF THE ITEMS BELOW before submitting your application. This ensures the speedy processing of your son’s application and also helps you check you have submitted all required items. – Thank you. Enrolment applications will only be accepted with all relevant documentation included. ⃝ Enrolment form – all pages completed ⃝ Signed conditions of enrolment (both parents) on Page 4 ⃝ Preference of Enrolment Certificated – endorsed at bottom of page 1 by Parish Priest or ⃝ Non Preference student – tick here ⃝ If born in New Zealand: a verified copy of your son’s birth certificate or passport (the original may be verified at the school office) If born outside of New Zealand you need to submit two items: 1. Valid residency visa or student permit 2. Your son’s passport (a photocopy will be made at the school office) ⃝ Full school report – a photocopy of your son’s most recent report
Please do not send in original documents or any material in clear files or bound documents Your application will not be processed unless all information requested has been submitted. Please mail or hand in your application to: Enrolments Liston College 69 Rathgar Road Henderson Auckland 0610 Applications may be dropped into Reception – Reception Hours Monday to Friday, 8am to 4pm, during term time only. Enquiries can be made to: Deirdre Auger, Principal’s PA. Ph. 09 8392291 Email: info@liston.school.nz
Quality Catholic Boys’ Education In the Edmund Rice Tradition