Hato Paora Enrollments Form – Fill Out and Use This PDF

DEVELOPING

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MAORI

LEADERS

APPLICATION FOR ENROLMENT

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HATO PAORA COLLEGE

APPLICATION FOR ENROLMENT

STUDENT INFORMATION

Proposed year of entry

Proposed Academic Year Level at Entry

Yr 9

Yr 10

Yr 11

Yr 12

Yr 13

Surname

First Name

Preferred Name

Date of Birth

/

/

Religion

Present School

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Yes

No

Present Year Level

Te Reo Maori Immersion

Ethnic Group(s)

Tribal Details Iwi

Hap

Waka

Iwi

Hap

Waka

Iwi

Hap

Waka

Custodial Parents

Both Parents

Father Only

Mother Only

Guardian

During the holidays student lives with

Both Parents

Father Only

Mother Only

Guardian

Father/Stepfather (circle as appropriate)

Mother/Stepmother (circle as appropriate)

Title

Title

Surname

Surname

First Names

First Names

Preferred Name

Preferred Name

Home Address

Home Address

Suburb

Suburb

City

City

Postcode

Postcode

Country

Country

3

Home email

Home email

Postal Address (If different to above)

Postal Address (If different to above)

Postcode

Postcode

Home Phone

(

)

Home Phone

(

)

Mobile Phone

(

)

Mobile Phone

(

)

Work Phone

(

)

Work Phone

(

)

Work Email

Work Email

Occupation

Occupation

Workplace Name

Workplace Name

Religion

Religion

Church Attended

Church Attended

PERSON RESPONSIBLE FOR PAYMENT OF FEES

Title

Surname

First Name

Relationship to Student

Home Email

Company/Trust (if applicable)

Postal Address

Suburb

City

Postcode

Home Phone (

)

Mobile (

)

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hato paora college - application for enrolment

MEDICAL DETAILS CONTINUED

Is your son currently taking any prescribed medication? Yes No

(If yes, please specify - Name of drug, dosage, frequency of medication)

Is your son under a Specialist or Doctor for any condition? Yes No (If yes, please specify)

Has your son used counselling services? Yes No

(If yes, please specify - Name of Counsellor, contact details and reason for counselling e.g. Anger Management etc)

Does your son have any allergies or other life threatening conditions? Yes No (If yes, please specify)

Has your son had any other medical, psychological or sexual issues that may affect his full participation in school life?

Yes No (If yes, please specify)

Has your son taken/used/ been involved with illegal drugs or substances? Yes No (If yes, please specify)

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Is your son fit for sport? Yes

No (If no, please specify)

Does your son wear: Prescription glasses

Yes

No

Contact lenses

Yes

No

Hearing aid

Yes

No

Does your son have recurrent problems with: Ears

Yes

No

Eyes

Yes

No

Nose

Yes

No

Throat

Yes

No

(If yes, please specify)

Has your son been immunised against: Polio

Yes

No

Hepatitis B/BCG

Yes

No

Measles/Mumps/Rubella

Yes

No

Whooping Cough/ Tetanus/Diphtheria

Yes

No

Meningococcal B

Yes

No

Other

Yes

No

(If yes, please specify)

Has your son had: Measles

Yes

No

Whooping cough

Yes No

Chicken pox

Yes

No

Mumps

Yes

No

Rheumatic fever

Yes

No

Appendicitis

Yes

No

Tonsillitis

Yes

No

Asthma

Yes

No ADHD Yes No

SPECIAL LEARNING NEEDS

Does your child have any Special Learning Needs?

Yes No

(If yes, please give details)

Has your child ever received learning assistance, or been part of a gifted & talented programme? Yes No

(If yes, please give details)

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hato paora college - application for enrolment

SPECIAL CIRCUMSTANCES

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Are there any special circumstances of which Hato Paora College staff should be aware?

(E.g. court orders, access arrangements etc) (If yes, please give details)

Has your child been subject to Children and Young Persons (CYP) referral or interest within the last two years?

Yes No (If yes, please specify)

Has your child been referred to an RLTB or GSE Service within the last two years? Yes No

(If yes, please give details)

Has your child ever been removed (i.e. excluded or withdrawn) from a school for disciplinary reasons? Yes No

(If yes, please give details)

REFEREE

List the name and address of one person (not relative) who will act as a referee for this application (e.g. Minister, employer, business associate, family friend, coach.) This should be a written reference supporting the student or wh nau.

(Please tick) I consent to the College approaching the nominated referee.

Name

Address

Home Phone (

)

Mobile (

)

Connection with Family/Student

7

DECLARATION

I/we declare that the information provided in this Enrolment Application is true and correct.

I/we understand that acceptance of this form does not constitute admission of the student.

I/we will be required to agree to the conditions of entry at the time an offer is made.

FatherÕs signature

Date

/

/

MotherÕs signature

Date

/

/

GuardianÕs signature (if applicable)

Date

/

/

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CHECKLIST FOR WHANAU

Passport photograph of the Applicant

Application Fee (non-refundable and payable to Hato Pora College)

Reference

Photocopy of the School Reports from the last two years

Baptismal Certicate

Photocopy identifying date of birth on a Birth Certicate or Passport

Any necessary Health Records from your family GP

Conrmation of any boarding or educational grants / scholarships

PRIVACY ACT

The information collected by the Hato Pora College during the Enrolment Process and during the period in which the student is enrolled at the College is intended for use in connection with assessing the suitability of the applicant and the subsequent education and well being of the student during their time at the College. Hato Pora College has, as its primary purpose, the academic and general education, and pastoral duty of care of students and shall obtain such information as necessary to achieve this purpose. The information collected may be used by any of the staff at the College or consultant to the College for that purpose. The information may be retained to enable the College to contact former students. Applicants have the right to access and request correction of any personal information collected by the College.

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hato paora college - application for enrolment

ADMISSION AGREEMENT

I acknowledge that, if my son is offered a place at Hato P ora College, I will be required at the time I accept such an offer to enter into an Admission Agreement with the College governing:

•the prompt payment of all tuition, boarding and other fees and expenses payable from time to time (and in default thereof the payment of interest and/or withdrawal of my child from the College);

•the observance by my son of the code of conduct and required behavioural and other standards of the College;

•full participation by my son in religious observance and instruction at the College, and other outdoor education activities;

•such other matters as the College’s Admission Agreement shall contain at the time I accept the College’s offer of a place for my son.

I enclose a non-refundable application fee of $250 (inclusive of GST) and acknowledge that this is an application fee only, and does not oblige the College to accept my child. I irrevocably authorise the College or any staff member, Trustee, Board member, consultant or professional advisor of the College to furnish to any third party, including but not by way of limitation, the persons named herein as being willing to support this application, details of this application and the information contained herein or to make enquiry of any third party in connection with this application and I irrevocably authorise any third party to provide you with such information as you may require concerning me and my child in connection with this application. I agree to notify the College of any change in the information contained in this application as soon as is reasonably practical.

This Application is to be signed by both parents or the applicable primary caregiver.

FatherÕs Signature

Date

/

/

MotherÕs Signature

Date

/

/

GuardianÕs Signature (If applicable)

Date

/

/

MEDICAL TREATMENT

Permission to the college to administer panadol and pharmaceuticals prescribed by a medical practitioner as and when necessary to my son.

I GIVE / DO NOT GIVE (please circle one)

8Permission for my son to be treated by the college doctor or nurse, dentist and health provider at the college’s discretion. I GIVE / DO NOT GIVE (please circle one)

Permission for my son to be given emergency medical treatment (including surgery) under the recommendation of a registered medical practitioner and the authority of the college management.

I GIVE / DO NOT GIVE (please circle one)

Permission for the college doctor or nurse to access my son’s medical records should it be necessary.

Signature		Date		/		/

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WHANAU

RIGHTS AND RESPONSIBILITIES

Hato Pora seeks to ensure the highest quality of care and safety for your son. Like all families living in close quarters for lengthy periods it is necessary to put in place sound ground rules for all, to ensure harmonious living, not only for your son, but for all students and staff.

Hato Pora College Hostel staff will act as “reasonable parents” whilst caring for and being responsible for your son. Teaching staff will conduct educational instructions in terms of their code of conduct and with the utmost professionalism.

We expect your son to accept and obey the lawful and reasonable instructions given by our staff.

STUDENT EXPECTATIONS (although this list is not exhaustive).

Students are not permitted to:

• Smoke cigarettes • Consume alcohol • Be involved in any way with illegal drugs or substances

• Swear at staff or fellow students • Bully • Be verbally or physically abusive

• Leave the property without permission from the Senior Management • Leave the property without signing out of the Hostel

• Trespass in any other dormitory • Use other’s property without permission • Be absent from class without permission

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hato paora college - application for enrolment

INTERNET ACCESS

Currently internet access is limited. However, the college redevelopment will allow for students to have regular access to email as another form of communication with whanau and friends.

EVENING STUDY

Compulsory study is held each weekday evening (excluding Friday).

SPORT

Your son must play at least one sport in summer and one sport in winter. Fees vary and will be charged against your account.

COLLEGE TRIPS

The college offers a range of cultural, academic and sporting trips both within Aotearoa-New Zealand and overseas. Your son may be invited to participate. Costs will be advised, when permission has been sought.

UNIFORM

DAY UNIFORM
2 blue college polo shirts	2 pairs summer weight grey school shorts	1 pair black roman sandals
2 pairs winter weight grey school shorts	1 college polar eece	1 pair blue college PE shorts
1 college PE shirt	1 college tracksuit (school issue)	2 pair grey school socks
CASUAL WEAR
3 sets of tidy casual wear	1 pair casual shoes	1 warm jacket

(Please ensure your son does not bring expensive labelled clothing to school)

	Underwear	Singlets	Pyjamas
	3 towels	Blanket(s) or duvet	1 school bag
	COMPULSORY FORMAL WEAR (NUMBER 1’S)
	1 college blazer	1 pair grey formal trousers	1 black trouser belt with a black buckle
	2 long sleeve white dress shirts	1 college tie	1 pair black dress shoes
	1 named see through suit cover	1 pair black socks
10	INFORMAL WEAR (NUMBER 2’S)
	1 red college jersey	1 red college sleeveless vest (optional)	1 pair grey formal trousers
	1 black trouser belt with a black buckle	1 blue college polo shirt	1 pair black socks
	SPORTS WEAR
	1 pair swimming shorts	1 college rugby jersey (school issue)	1 practice jersey
	1 pair rugby boots	1 pair running shoes	1 pair training shorts

ALL ITEMS MUST BE CLEARLY NAMED.

RIGHTS AND RESPONSIBILITIES

Further Contractual Consent to terms and conditions of Enrolment at Hato Pora College:

Upon this application being successful, this document becomes a contract between the parties, as contained within and signed below.

One term’s prior notice in writing must be given (exceptional circumstances aside) before a student is withdrawn from the Hostel. Inadequate notice will lead to that term’s fees being forfeited.

Parents/Legal Guardians are required to ensure that payment of fees is made one term in advance.

Hato Pora College reserves the right to deny a place in the hostels to any student whose parents have an overdue account.

Jointly and severally you are responsible for boarding fees and attendance dues (as determined by the Proprietors).

Hato Pora College reserves the right to recover all costs including debt recovery, legal fees and all or any other expenses incidental to overdue accounts for boarding fees and attendance dues.

Parents/Legal Guardians accept that students will participate in the general College programme that gives the College its Special Character.

Parents/Legal Guardians are encouraged to ensure that their son has an EFTPOS bank account and to lodge sufcient funds in that bank account to cover any personal requirements like toiletries, stationery and tuckshop.

The principal may authorise a search of my son's personal property when there is concern about theft or about the possible use and/or possession of alcohol, drugs, solvents and other harmful substances in the college.

Under the college’s Integration Agreement with the Crown, We/I note and acknowledge that the Proprietor “has the right to require Parents, or other persons accepting responsibility of any child to remove that child from the boarding establishment.

We/I give permission for Hostel Management to see our son’s school report to help them assist with his learning needs while at study.

We/I understand what is required of us nancially to support our son as a student at Hato Pora.

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hato paora college - application for enrolment

RIGHTS AND RESPONSIBILITIES

STUDENT COMPUTER AND INTERNET USE AGREEMENT

Internet access is available to students, and staff of Hato Pora College. We believe the Internet offers vast and diverse-resources to students and staff. This service will help to promote educational excellence in our school and hostel by facilitating resource sharing, communication and skills in nding and using information and innovative programmes.

The Internet is an electronic highway connecting millions of people and their computers world wide. Students and staff at Hato Pora College have access to:

1 Electronic communication with people all over the world

2 Information from government sources, research institutions and many other sources

Access to people and computers all over the world also allows for the availability of material that may not be considered of educational value in the context of the college setting. On a global network, it is impossible to control all materials and an industrious user may discover controversial information. We rmly believe that the valuable information and interaction available on the Internet far outweighs the possibility that users may access material that is not consistent with the Learning Outcomes of the Curriculum. Life is a series of choices and consequences. Hato Pora College has chosen to make Internet resources available to students, the consequence being that they can readily access enormous amounts of information.

If a student chooses to access resources that are objectionable, adult-oriented, or restricted, the consequences will be suspension or termination of continuing access. The signatures at the end of this document indicate that the signatories have read the terms and conditions and agree to abide by those terms.

COMPUTER AND INTERNET TERMS AND CONDITIONS

ACCEPTABLE USE

The original purpose of the Internet was and largely still is, to support research and education in and among academic institutions all over the world by providing access to unique resources. The use of Hato Pora computers must support education and outcomes that are consistent with the learning opportunities of the Curriculum.

Use of another organisations’ network or computing resources must comply with the rules appropriate for that network. Transmission of any material in violation of any NZ regulation is strictly prohibited. This includes but is not limited to material protected by trade secret.

ELECTRONIC MAIL (EMAIL)

Students are not allowed to use the various email services available on the Internet e.g. Hotmail. Individual email accounts for

12students are available from the school and will be setup for each student.

INAPPROPRIATE USE

Hato Pora College staff and the Principal will determine what constitutes inappropriate use. The Principal may request the suspension or termination of computer access and use of any user who violates these acceptable practices.

STUDENT

I have read this agreement and understand the importance of the school rules for the use of computers, the Internet and will abide by the above use agreement.

I further understand that any violation of the regulations above is unethical and may constitute a criminal offence. Should I commit any violation, my access privileges may be revoked, and college disciplinary action may be taken and/or appropriate legal action may be instituted.

Student's Name						(Please print)
Students Signature			Date		/			/

PARENT/LEGAL GUARDIAN

As the parent or guardian of this student, We/I have read this agreement and understand that my son is responsible for using college equipment and the Internet as outlined.

We/I recognize that it is impossible for Hato Pora College to restrict access to all controversial materials and will not hold the college personnel responsible for material acquired on the Internet.

I hereby give permission to allow Internet access for my son.

Parent/Legal Guardian Name						(Please print)
Signature			Date		/			/
Parent/Legal Guardian Name						(Please print)
Signature			Date		/			/

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hato paora college - application for enrolment

APPLICATION FOR PREFERENCE ENROLMENT

NEW ZEALAND CATHOLIC DIOCESE PREFERENCE OF ENROLMENT CERTIFICATE

FOR THE CATHOLIC DIOCESE OF PALMERSTON NORTH

This is to certify that in accordance with Private Schools’ Conditional Integration Act, Section 29(1), and Catholic School Integration Agreements, through a general or particular religious connection as stated in the Preference Criteria Numbers 5.1, 5.2, 5.3, 5.4, 5.5.

(Please refer to Criteria on the next page)

Mr/Mrs/Ms

Address

Is/are eligible to have preference of enrolment for their son at Hato Pora College, Feilding.

Name of Student

I/we undertake to support our child in the formation of their faith and the practices of the Catholic Church.

Parent(s)/Caregivers Signature		Date		/		/

Under which criterion (see next page) is the student eligible for preference?

If Criterion 5.1 applies please complete:

Baptised in

at

on

/

/

If Criterion 5.4 applies please complete the section on the next page.

Certified by (Name)		as authorised agent of the

Roman Cathloic Bishop of the Diocese of

Position

(see: Administration of the Criteria, 6.1.1-6.1.6, Agents who may sign, listed over page)

Address										13
Signature			Date		/		/

This form must be completed by the Parent(s)/Caregiver(s), and the Parish Priest or other designated authorities prior to the enrolment of a student in a Catholic Integrated School.

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hato paora college - application for enrolment

ATTENDANCE DUES AGREEMENT FORM

students attending Catholic Schools are required to pay Attendance dues. These are for servicing school debts, insurance of school buildings, and costs permitted by legislation. The billing of Attendance Dues is centralised through Catholic Schools Board Limited (CSBL) at the Catholic Centre, PO Box 12 - 341, Wellington.

Prior to enrolment, the parents, or other persons taking responsibility for the student, must agree to pay Attendance Dues at a rate determined by the Proprietors and approved by the Minister of Education, or at such other rates as may be agrees from time to time between the undersigned and the person delegated by the Proprietors to act on their behalf.

The Catholic Schools Board Limited will send four invoices through the year, the rst on or about 1 March, for the total family attendance dues to be paid.

In the event of default in payment, then recovery costs will be an additional expense to the parent or caregiver.

I/We the undersigned agree as a condition of enrolment and attendance to pay attendance at the rate levied from time to time by the school Proprietor.

Name				Name
		(Please print)				(Please print)
Address				Address

Signed			Signed
		(Please print)		(Please print)
Student Name

PRIVACY ACT 1993

The information given in the enrolment form may be disclosed to the Proprietor, or his/her agents, for the Purpose of attendance

dues an other purposes provided or envisaged by law.								15
We hereby consent to this use:
Signed								Signed
						(Parent/Caregiver)			(Parent/Caregiver)
Date			/		/

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hato paora college - application for enrolment

DEVELOPING

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MAORI LEADERS SPIRITUALLY INTELLECTUALLY PHYSICALLY ARTISTICALLY SOCIALLY AND EMOTIONALLY

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HATO PAORA MAORI BOYS COLLEGE

KIMBOLTON ROAD, RD7, FEILDING 4777 | P 06 328 9731

www.hatopaora.maori.nz