Southern Regional Health School
Online Enrolment


Use this form to apply for enrolment at Southern Health School (SHS). Please note that enrolment is not automatic and is subject to entry criteria.

Key Requirements

Application form: Please provide as much detail as you can. Required fields are marked with an asterisk (*).

Southern Health School Medical Form: Applications require a Southern Health School medical certificate completed by the student’s treating doctor. We cannot process your application until this is received. Attach the medical form at the end of this application or email it to secretary@southernhealth.school.nz.

Please read our Community Classroom and Internet Information here before filling in the application. They are part of the required permissions.

To ensure this application reaches us, make sure to complete the final step clicking the SUBMIT INFORMATION button on page 3

Tip: Feel free to have a trusted person assist you with this application or contact the school office (03) 3666739 for support.
Application Form

Student Details

Legal Surname *
Legal First Name *
Middle Name
Preferred Surname
Preferred First Name
Date of birth *
select
Gender *
Cell phone #Only Numbers and spaces are allowed e.g. 012 1234567
Country Or Jurisdiction Of Citizenship *
Language At Home
Ethnicities * Maximum 4 Allowed
Iwi Maximum 16 Allowed
Main School of Enrolment
Eligibility Criteria *

Additional Details

The information below is collected for the purposes of:

-Ensuring we are in collaborative contact with other agencies involved with the student

-Determining the learning needs of the student

-Collecting statistical data

*
*
*
*
*
*

Caregiver Details (Minimum 1)

Caregiver # 1 (This caregiver must live with the student)
Relationship *
Gender *
Select As Applicable *
Surname *
First Name *
Email *
Phone # Home Only Numbers and spaces are allowed e.g. 06 1234567
Phone # Work Only Numbers and spaces are allowed e.g. 06 1234567
Phone # Cell *Only Numbers and spaces are allowed e.g. 012 1234567
Search Address
Street *
Suburb *
City *
Post Code *
State / Province
Country *

Starting Year Level (at this school)
Photo Publication Consent *
Internet Permission *

Medical Information

Doctor
Medical Centre
Medical Consent *
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