Enrol Online

Child's Details
Child’s official surname or family name:*
Child’s official given name:*
Child’s official other names / middle names:
(please separate names with a comma)
Name your child is known by / preferred name:
Surname / family name: Given name:
Copy of official identity verification document* collected by staff:*
- New Zealand birth certificate
- New Zealand passport
- Foreign birth certificate
- Foreign passport
Child’s date of birth:*
Gender:*
- Male
- Female
Child’s ethnic origin/s:
Iwi your child belongs to:
Language/s spoken at home:
Child’s primary residential address:*
Post Code:*

Enrolment Details
Date of Enrolment:*
Date of Entry

DD
MM
YYYY
Days / Times Enrolled
Monday Tuesday Wednesday Thursday Friday TOTAL HOURS
(Enter times enrolled for each relevant day)
Parent/Guardian Name:*
Today's Date*

DD
MM
YYYY

Parents / Guardians:
Guardian 1:
Given names:*
Surname / family name:*
Address (if different from child):
(incl post code)
Phone Numbers:*
Home Work Mobile
Email*
Relationship to child:*
Guardian 2:
Given names:
Surname / family name:
Address (if different from child):
(incl post code)
Phone Numbers:
Home Work Mobile
Email
Relationship to child:
Additional Emergency Contacts (also able to pick up child):
Emergency Contact 1:
Given names:
Surname / family name:
Address:
(incl post code)
Phone Numbers:
Home Work Mobile
Email
Emergency Contact 2:
Given names:
Surname / family name:
Address:
(incl post code)
Phone Numbers:
Home Work Mobile
Email
Custodial Statement
Are there any custodial arrangements concerning your child?*
- Yes
- No
If YES, please produce an original copy of any custodial arrangements or court orders for The Blue Cottage to copy and keep on file.
Person/s who cannot pick up your child:
Name: Name: Name: Name:

Terms & Conditions
- Policy Statement: The Blue Cottage has a number of policies that set out the procedures that are in place for the care and education of the children who attend. We strongly urge you to read these. The signing of this enrolment agreement form indicates that you will abide by the policies of this service. A full copy is available upon request.
- Excursions: I give permission for my child to take part in regular excursions as per The Blue Cottage Excursion Policy. I understand this includes spontaneous, short walks with the teacher/s in the local area but I will be required to give written permission for extended excursions or those involving travel by motor vehicle.
- Child Health: I have read and understand the accident policy and agree to abide by the child health and infectious illnesses policy.
- Fees: In signing this, I agree to pay the fees as stated in the Fees Policy. The Blue Cottage is closed on all Statutory Holidays.
- Arriving and Departing: I agree that when dropping my child off at The Blue Cottage, I will park in designated area and will escort my child into the building and advise a teacher of my arrival before leaving my child in the centres custody. I will advise a teacher before taking my child from the centre. I will sign my child in on arrival and out on departure daily. I understand and accept that this is a condition of enrolment that children driven to and from The Blue Cottage must travel in a child’s car seat or restraint in accordance with Traffic Regulations.
- ICT: I agree that as part of their learning environment, my child may be involved in the use of ICT.
- Health Tests: I give permission for my child to have vision, hearing and other tests by qualified professionals considered to be in the best interest of my child and that the results be discussed with the teacher if relevant.
- Planning/Assessment: I give permission for my child to be photographed or videoed as part of The Blue Cottage’s assessment, planning and evaluation.
- Enrolment Rights: I understand that acceptance of my child at The Blue Cottage is in no way an assurance or guarantee of continued enrolment for the time indicated or under the terms and conditions effective a the time of enrolment.
- Privacy Statement: We are collecting personal information on this enrolment form for the purpose of providing early education for your child. We will use and disclose your child’s information only in accordance with the Privacy Act 1993. Under that Act you have the right to access and request correction of any personal information we hold about you or your child. Details about your child’s identity will be shared with the Ministry of Education so that it can allocate a national student number for your child. This unique identifier will be used for research, statistics, funding, and the measurement of educational outcomes. You can find more information about national student numbers at: eli.education.govt.nz
Images: I agree for my child’s image and first name to be used for promotional material (answer YES or NO)*
Newsletter Printed Materials Website* Facebook*
I understand that these images will be available on the world wide web and will be viewed by visitors to the website
Declaration
I declare that all the above information is true and correct to the best of my knowledge.
Parent/Guardian Name:*
Date*

DD
MM
YYYY

Enrol

Step 1 of 6 - Childs Details

Child's Details

Enrolment Details

Parents / Guardians:

Additional Emergency Contacts (also able to pick up child):

Custodial Statement

Child's Doctor

Health

Medicine

20 Hours ECE Attestation: Only for 3 to 5 year olds

Dual Enrolment Declaration

How did you hear about us?

Terms & Conditions

Declaration