Reference:

Application for Enrolment

Student Details
Full name of student: Known as: Date of Birth: Country of Birth: Nationality: Penn, Jackson-Thomas Elijah JT Penn 2002-11-17 155 155 Current school and year: Religious Denomination: Ethnic Origin: Iwi: Gracefield School (Year 5) Christian Samoan, Maori, Indian Ngati Porou

Please attach proof of your Domestic Status This can be either a photocopy of the Student's NZ Birth Certificate, a NZ Passport, residents permit, parents work permit or similar. Note: We are required by the Ministry of Education to hold copies of these on file.

First language: Address:

English 21 Mandel Mews Gracefield Lower Hutt 5010 2013-01-28 Year 6

Second language: Phone: 04 5694101

Commence at Scots: Expected Year Level:

Enrolled as a:

Fathers details
Name: Year of birth: Address: Mr Steve Penn 03 July 1969 21 Mandel Mews Gracefield Lower Hutt 5010 Home: 04 5694101 Work: 210 2225 Mobile: 027 2305091 Email: Occupation: spenn@slingshot.co.nz Test Analyst

Mothers details
Name: Year of birth: Address: Mrs Christine Penn 05 August 1974 21 Mandel Mews Gracefield Lower Hutt 5010 Home: 04 5694101 Work: Mobile: 0274 748792 Email: Occupation: cpenn@slingshot.co.nz Test Analyst

Phone:

Phone:

Family association with the College

Grandson of a former student: Child of a former student: Sibling of a former student: Sibling of a present student: Other association (1990 - 1994): How did you hear about Scots College? Jacob Morris 3 Uncle

References

Reference 1
Name: Phone: Address: Charlotte Tait 570 0737

Reference 2
Name: Phone: Address: Jeannine Serevi 027 3540363 175 Onepu Rd Kilbirnie Wellington

I enclose the sum of $150 being Enrolment Processing Charge including GST. This sum is not refundable. I understand that confirmation of application should be made six months prior to the time my son would commence at Scots College. (Proof of Nationality must be sighted at interview Ministry of Education requirement.) I understand that this application is a preliminary one only and that no assurance is given that my son will be accepted when confirmation of application is made. We / I agree to emails being sent for any communications relating to College / our sons activities in accordance with the Unsolicited

Electronic Messages Act 2007

Privacy Act
The information in this form is collected for Scots College records. The information will also allow us to keep in touch with you until the application is considered during the year before entry. This information, and any other information collected relating to the student will be used to provide for the educational and general advancement of the student and for the purpose of carrying out the activities of the College. Any information collected by the College may be provided Child to education authorities (under Section 7(4) of the Privacy Act 1993) or to the student, parent, caregiver or guardian at the Colleges discretion. The College may also release this information to parties outside the College at the discretion of the Headmaster where it relates to the education, health, welfare or safety of the student. If this application for admission does not succeed, the information on this form will be kept on our records unless otherwise indicated.

I / we agree I / we have read and acknowledge the Privacy Act statement and give permission to the College to collect, store and disclose information accordingly.

Signature of Mother:

Date:

Signature of Father:

Date:

Please forward this form, together with the Enrolment Processing Charge to: Enrolments Scots College Box 15-064 Miramar Wellington 6243 New Zealand

For College use only

Enrolment Processing Charge Receipt Issued: Application Form acknowledged: Student Roll Number: