Enrol | Riverside Educare | Wanaka Early Childhood Centre

Enrolment

Child's details

Child’s official given name

Child’s official other names/middle names

Child’s official surname or family name

Child’s preferred name

Child's date of birth

Gender

Female

Male

Ethnic identity

Iwi Affiliation

Child’s primary residential address

Address Line 1

Address Line 2

City

Zip Code

Doctor

Doctor's name

Doctor's practice

Doctor's phone number

Child's health

Illness / allergies:

Has your child been immunised?

Yes

Family details

Parents / Guardian 01

Given names:

Surname / family name:

Email:

Address same as childs?

Yes

Address Line 1

Address Line 2

City

Zip Code

Home phone number:

Work phone number:

Mobile number:

Relationship to child:

Parent / Guardian 02

Given names

Surname / family name

Address same as childs?

Yes

Address Line 1

Address Line 2

City

Zip Code

Home phone number:

Work phone number:

Mobile number:

Relationship to child:

Emergency contact

This person must live locally and be contactable in case of emergency where both parents cannot be contacted.

Name

Home phone number:

Mobile number:

Relationship to child:

Important information

I give permission for centre staff to apply nappy barrier cream (supplied by parents), Arnica cream, insect bite preparations (Scratchy & Itchy Gel) and sunscreen to my child as required.

Yes

Signed

I give permission for my child to go on spontaneous walking excursions outside of the centre in accordance with the centre's excursion policy which I have read and agree with.

Yes

Signed

I give permission for my child to be photographed for the purpose of public relations (some photos may be used on our website, our private facebook page, story park…)

Yes

Signed

Authorised collection persons

Please list all adults authorised to collect your child

Please list all adults NOT authorised to collect your child

(If you have any custodial arrangements or court orders concerning your child a copy must be provided for the centre)

Waitlist details

Preferred start date:

Monday:

Yes

Time:

Tuesday:

Yes

Time:

Wednesday:

Yes

Time:

Thursday:

Yes

Time:

Friday:

Yes

Time:

If you are not sure on days/times or if there is anything about your child’s bookings (for example, changing booked hours or days after a month) please make a note of this below:

Privacy statement

All early childhood services must meet their responsibilities under the Privacy Act 2020, which include providing a Privacy statement on enrolment agreements which meets the requirements of that Act (see Principle 3 - Collection of information from subject).

Additionally, all Privacy statements must include the exact wording below:

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

Early childhood services can find out more information about NSN assignment – including acceptable identity verification documents – at: National Student Numbers (NSN) – Education in New Zealand

The Ministry recommends keeping a record of identity verification documents that have been sighted, but not retaining copies of identity verification documents, which if received, should be securely destroyed once verified.

One of the following official identity verification documents will need to be sited by staff:

New Zealand birth certificate
Foreign birth certificate
New Zealand passport
Foreign passport

Signed

Date