Miramar Central School
Online Enrolment

Welcome to Miramar Central School
Application Form

Student Details

Legal Surname *
Legal First Name *
Middle Name
Preferred Surname
Preferred First Name *
Date of birth *
select
Gender *
NSN
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
Verification Document *
Document Expiry Date
select
Document Serial Number *
Date Of Arrival In NZ
select
Previous School
Eligibility Criteria *

Additional Details

Bike Track

I give permission for my child to take part in the Pedal Ready and Bike Ready cyclist skills training

programme on the school track 

Please indicate if your child has any medical conditions or other needs that the course instructor needs to

be aware of:

___________________________________________________________________



School Newsletter:

I would like to receive my school newsletter via Email



Sports Teams:

I give permission for my contact details to be given to my child’s sports team coach.

Caregiver Details (Minimum 1)

Caregiver # 1 (This caregiver must live with the student)
Relationship *
Gender *
Select As Applicable *
Title
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)
Date First Started Any School
select
Start Date At This School
select
Early Childhood Education
Photo Publication Consent
Internet Permission *
EOTC Permission

Medical Information

Doctor
Medical Centre
Phone NumberOnly Numbers and spaces are allowed
Alternative Phone NumberOnly Numbers and spaces are allowed
Address Street
Suburb
City
Pain Relief Permission *
Medical Consent *
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