Southcity Christian School

Family Name:________________________________________________________

Child’s First Name: ____________________________________ Male / Female

Date of Birth: ________________________

Address: ____________________________________________________________

Phone: _____________________________

Ethnic Group: _______________________

If Maori, please state Iwi: _______________

Previous School / Kindergarten: ____________________________________

Current Year Level: ____________________

Date to Begin: ________________________

Doctor: ________________________ Doctor’s Phone: __________________

Any medical details the school should know:

________________________________________________________________________

________________________________________________________________________

Any educational, physical, emotional, or behavioural difficulties that could
affect learning:

________________________________________________________________________

________________________________________________________________________

FAMILY PROFILE
Please state the names of parents/carers the child is living with:

Father’s Name: ___________________ Occupation: _____________________

WorkPhone: _____________________

Mother’s Name: __________________ Occupation: _____________________

Work Phone: ____________________

Caregiver: ______________________ Occupation: _____________________

Work Phone: ____________________

Family Circumstances: ______________________________________________________
Mother or Father’s name if not living with the child:

__________________________________________________________________________
Contact Person (Name of person the school can contact in an emergency if they
are unable to contact parent/caregiver):
Name: ______________________________________________________________________

Address: ___________________________________________________________________

Town/City: ____________________________ Phone: ______________________

Relationship to Child: _____________________________________________________

Special Character Details (Preference Position):
I / We have read the Statement of Faith and fully subscribe to the principles
stated therein.

Signed: ______________________________

Church Fellowship: _________________________________________________________

Pastor’s Name: _____________________________________________________________
(If applying for a Preference Position please attach a letter from your Pastor).

DECLARATION
Why do you want your child to attend this school?

________________________________________________________________________

________________________________________________________________________
How did you hear about our school?

________________________________________________________________________

I/we agree to support the schools policies and codes.

I understand that attendance dues are compulsory and I will make every
effort to keep these paid on time.

I/we understand that a month’s notice must be given if a child intends
leaving the school - or a month’s attendance dues will be charged.

Signed (Only one signature is necessary)

Father: ________________________ Date: __________________________

Mother: ________________________ Date: __________________________

Caregiver: _______________________ Date: __________________________

OFFICE USE ONLY

Accepted Declined

Preference Position

Non-Preference Position

Immunisation Certificate

Notes: __________________________________________________________________

__________________________________________________________________