Child Details

Name your child is known by / preferred name:

Given name

Surname/family name

Child’s official first name

Child’s official last name

Official Middle Name 1

Official Middle Name 2

Birth Date

Gender

Please Select.. Female Male Unknown

Residential Address

Alternative Address

Languages

English Afrikaans Albanian American Sign Language Amerind Amharic Arabic Armenian Artificial Languages not elsewhere classified Artificial Languages not further defined Assyrian Australian Australian Sign Language Azeri Bahasa Indonesia Baltic not elsewhere classified Baltic not further defined Bantu not further defined Bantu, not elsewhere classified Basque Belorussian Bengali Bisayan Bislama Breton British Sign Language Bulgarian Burmese Catalan Caucasian not elsewhere classified Caucasian not further defined Cebuano Celtic not elsewhere classified Celtic not further defined Central Pacific not elsewhere classified Central Pacific not further defined Chadic not elsewhere classified Chadic not further defined Cook Islands Maori Creole Croatian Cushitic not elsewhere classified Cushitic not further defined Czech Danish Don’t know Dravidian not elsewhere classified Dravidian not further defined Dutch Esperanto Estonian Fiji Hindi Fijian Finnish French French Creole Friesian Fulani Georgian German Greek Gujarati Hakka Hausa Hebrew Hindi Hindi Bat Hungarian Icelandic Ilokano Indo-Aryan not elsewhere classified Indo-Aryan not further defined Iranian not elsewhere classified Iranian not further defined Irish Italian Japanese Javanese Kannada Kashmiri Khmer Kiribati Konkani Korean Kurdish Language Isolates not elsewhere classified Lao Latvian Lithuanian Macedonian Malayalam Malaysian Maltese Māori Marathi Mauritian Creole Miao-Yao Micronesian not elsewhere classified Micronesian not further defined Min Mon-Khmer not elsewhere classified Mon-Khmer not further defined Moriori Nauruan Neo Melanesian Nepalese New Zealand Sign Language Nilo-Saharan Niuean None ‘(eg too young to talk) North Germanic not further defined Northern Chinese (Mandarin) Norwegian Not Stated Oriya Other Miscellaneous Languages Other Niger-Congo not elsewhere classified Other Niger-Congo not further defined Panjabi Papuan Pashto Persian Pidgin English Pidgins and Creoles not elsewhere classified Pidgins and Creoles not further defined Polish Portuguese Pukapukan Refused to answer Response outside scope Response unidentifiable Romance not elsewhere classified Romance not further defined Romani Romanian Rotuman Russian Samoan Scots Scottish Gaelic Semitic not elsewhere classified Semitic not further defined Serbo-Croatian Shan Sign Language not further defined Signed English Sindhi Sinhala Sinitic not elsewhere classified Sinitic not further defined Slavic not elsewhere classified Slavic not further defined Slovak Slovene Solomon Islands Languages (Non-Central-Pacific) Solomon Islands Pidgin Somali Spanish Swahili Swedish Tagalog (Filipino) Tahitian Tai-Kadai not elsewhere classified Tai-Kadai not further defined Tamil Telugu Thai Tibetan Tibeto-Lolo-Burman not elsewhere classified Tibeto-Lolo-Burman not further defined Tieu-Chow Tigrinya Tok Pisin Tokelauan Tongan Turkish Turko-Altaic not elsewhere classified Turko-Altaic not further defined Tuvaluan Ukrainian Uralic not elsewhere classified Uralic not further defined Urdu Vanuatu Languages Viet-Muong not elsewhere classified Viet-Muong not further defined Vietnamese Welsh West Germanic not elsewhere classified West Germanic not further defined Western Malayo-Polynesian not elsewhere classified Western Malayo-Polynesian not further defined Wu Yiddish Yoruba Yue (Cantonese) Zulu

Ethnicity

Māori NZ European / Pākehā Admiralty Islander Afghan African African American Afrikaner Aitutaki Islander Albanian Algerian American Anglo Indian Arab Argentinian Armenian Asian Assyrian Atiu Islander Austral Islander Australian Austrian Banaban Bangladeshi Belgian Belorussian Bengali Bismark Archipelagoan Bolivian Bosnian Bougainvillean Brazilian British Bulgarian Burgher Burmese Cambodian Cambodian Chinese Canadian Caroline Islander Celtic Chamorro Channel Islander Chilean Chinese Colombian Cook Islands Māori Cornish Corsican Costa Rican Croatian Cypriot Czech Dalmatian Danish Dutch Easter Islander Ecuadorian Egyptian English Eritrean Estonian Ethiopian Eurasian European Falkland Islander Fijian Fijian Indian Filipino Finnish Flemish French Gaelic Gambier Islander German Ghanaian Greek Greenlander Guadalcanalian Guatemalan Gujarati Guyanese Hawaiian Honduran Hong Kong Chinese Hungarian Icelandic Indian Indian Tamil Indigenous American Indigenous Australian Indonesian Inuit Iranian/Persian Iraqi Irish Israeli/Jewish Italian Jamaican Japanese Jordanian Kanak Kenyan Kiribati Korean Kurd Laotian Latin American Latin American Creole Latvian Lebanese Libyan Lithuanian Macedonian Malaitian Malay Malaysian Chinese Maltese Malvinian Mangaia Islander Manihiki Islander Manus Islander Manx Marianas Islander Marquesas Islander Marshall Islander Mauke Islander Mauritian Mexican Middle Eastern Mitiaro Islander Moroccan Nauruan Nepali New Britain Islander New Caledonian New Georgian New Irelander Ni Vanuatu Nicaraguan Nigerian Niuean North American Indian Norwegian Not Stated Omani Orkney Islander Other Ethnicity Other South African Pacific Peoples Pakistani Palau Islander Palestinian Palmerston Islander Panamanian Papua New Guinean Paraguayan Penrhyn Islander Peruvian Phoenix Islander Pitcairn Islander Polish Portuguese Puerto Rican Pukapuka Islander Punjabi Rakahanga Islander Rarotongan Romani Romanian Rotuman Russian Samoan Santa Cruz Islander Sardinian Scottish Serbian Seychellois Shetland Islander Sikh Singaporean Chinese Sinhalese Slavic Slovak Slovenian Solomon Islander Somali South African South American Indian South Slav Southeast Asian Spanish Sri Lankan Sri Lankan Tamil Swedish Swiss Syrian Tahitian Taiwanese Thai Tibetan Tokelauan Tongan Torres Strait Islander Tuamotu Islander Tunisian Turkish Tuvaluan Ugandan Ukrainian United States Creole Uruguayan Venezuelan Vietnamese Vietnamese Chinese Wake Islander Wallis Islander Welsh West Indian Yap Islander Yemeni Zimbabwean

IWI

Aotea, iwi not named Don’t Know Hapū Affiliated to More Than One Iwi Hauraki / Pare Hauraki, iwi not named Hauraki Region, Iwi not named Horouta, iwi not named iwi 0200 iwi 0209 iwi 0400 iwi 0500 iwi 0600 iwi 0705 iwi 0800 iwi 0900 iwi 2200 Kāti Māmoe Kurahaupō, iwi not named Mahuru, iwi not named Māmari, iwi not named Manawatū/Horowhenua/Te Whanganui-a-Tara Region, Iwi not named Mātaatua, iwi not named Maungaharuru Tangitū Mōkai Pātea, iwi not named Moriori Muaūpoko Muriwhenua, iwi not named Ngā Pōtiki ā Tamapahore Ngā Rauru Ngāi Tahu / Kāi Tahu Ngāi Tai (Tauranga Moana/Mātaatua) Ngāi Tai ki Tāmaki Ngāi Tai, region not known Ngāi Takoto Ngāi Tāmanuhiri Ngāi Te Ohuake (Rangitīkei) Ngāi Te Rangi Ngāpuhi Ngāpuhi ki Whaingaroa-Ngāti Kahu ki Whaingaroa Ngaruahine Ngāti Apa (Rangitīkei) Ngāti Apa ki Te Rā Tō Ngāti Apa, region not known Ngāti Awa Ngāti Hako Ngāti Haua (Taumarunui) Ngāti Haua (Waikato) Ngāti Haua, region not known Ngāti Hauiti Ngāti Hei Ngāti Hīkairo Ngāti Hine (Te Tai Tokerau) Ngati Hinemanu (Heretaunga) Ngati Hinemanu (Rangitikei) Ngati Hinemanu, region not known Ngati Hinerangi Ngāti Hineuru Ngati Huarere Ngāti Kahu Ngāti Kahungunu ki Heretaunga Ngāti Kahungunu ki Tamakinui a Rua Ngāti Kahungunu ki Tamatea Ngāti Kahungunu ki Te Wairoa Ngāti Kahungunu ki Te Whanganui-a-Orotu Ngāti Kahungunu ki Wairarapa Ngāti Kahungunu, region not known Ngāti Kauwhata Ngāti Kearoa / Ngāti Tuarā Ngāti Koata Ngāti Korokī Kahukura Ngāti Kuia Ngāti Kurī Ngāti Mākino Ngāti Manawa Ngāti Maniapoto Ngāti Manuhiri Ngāti Maru (Marutuahu) Ngāti Maru (Taranaki) Ngāti Maru, region not known Ngāti Mutunga (Taranaki) Ngāti Mutunga (Wharekauri/Chatham Islands) Ngāti Mutunga, region not known Ngāti Pāhauwera Ngāti Paoa Ngāti Pikiao (Te Arawa) Ngāti Porou Ngāti Porou ki Harataunga ki Mataora Ngāti Pūkenga Ngāti Pūkenga ki Waiau Ngāti Rāhiri Tumutumu Ngāti Rākaipaaka Ngāti Rangi (Ruapehu, Whanganui) Ngāti Ranginui Ngāti Rangiteaorere (Te Arawa) Ngāti Rangitihi (Te Arawa) Ngāti Rangiwewehi (Te Arawa) Ngāti Rārua Ngāti Raukawa (Horowhenua/Manawatū) Ngāti Raukawa, region not known Ngati Rehua Ngāti Rongomai (Te Arawa) Ngāti Ruanui Ngāti Ruapani ki Waikaremoana Ngāti Tahu-Ngāti Whaoa (Te Arawa) Ngāti Tama (Taranaki) Ngati Tama ki Te Tauihu Ngāti Tama ki Te Upoko o Te Ika (Te Whanganui-a-Tara/Wellington) Ngāti Tama, region not known Ngāti Tamakōpiri (Rangitīkei) Ngāti Tamaoho Ngāti Tamaterā Ngāti Tara Tokanui Ngāti Tarāwhai (Te Arawa) Ngāti Te Ata Ngati Tiipa Ngāti Toa, region not known Ngāti Toarangatira (Te Waipounamu/South Island) Ngāti Toarangatira (Te Whanganui-a-Tara/Wellington) Ngati Torehina ki Mata-ure o Hau Ngāti Tukorehe Ngāti Tūwharetoa (ki Taupō) Ngāti Tūwharetoa ki Kawerau Ngāti Tūwharetoa, region not known Ngāti Wai Ngāti Whakaue (Te Arawa) Ngāti Whanaunga Ngāti Whare Ngāti Whātua (not Ōrākei or Kaipara) Ngāti Whātua o Kaipara Ngāti Whātua o Ōrākei Ngāti Whitikaupeka (Rangitīkei) Ngātokimatawhaorua, iwi not named Not Stated Nukutere, iwi not named Pakakohi Patukirikiri Rangitāne (Manawatū) Rangitāne (Te Matau-a-Māui/Hawke’s Bay/Wairarapa) Rangitāne (Te Waipounamu/South Island) Rangitāne o Tamaki nui ā Rua Rangitāne, region not known Raukawa (Waikato) Refused To Answer Rekohu/Wharekauri Region, Imi/Iwi not named Rereahu Response Outside Scope Response Unidentifiable Rongomaiwahine (Te Māhia) Rongowhakaata Tainui Awhiro Tainui, iwi not named Tākitimu, iwi not named Tamahaki (Ruapehu, Waimarino) Tamakana (Ruapehu, Waimarino) Tangāhoe Tapuika (Te Arawa) Taranaki Taranaki Region, Iwi not named Tauranga Moana, iwi not named Tauranga Moana/Mātaatua Region, Iwi not named Te Aitanga ā Hauiti Te Aitanga-a-Māhaki Te Ākitai-Waiohua Te Arawa, iwi not named Te Arawa/Taupō Region, Iwi not named Te Ati Haunui-a-Pāpārangi Te Atiawa (Taranaki) Te Atiawa (Te Waipounamu/South Island) Te Atiawa (Te Whanganui-a-Tara/Wellington) Te Atiawa ki Whakarongotai Te Atiawa, region not known Te Aupōuri Te Hika o Pāpāuma Te Kawerau ā Maki Te Matau-a-Māui/Wairarapa Region, Iwi not named Te Paatu Te Rarawa Te Roroa Te Tai Rāwhiti Region, Iwi not named Te Tai Tokerau/Tāmaki-makaurau Region, Iwi not named Te Tauihu o Te Waka a Māui, iwi not named Te Upokorehe Te Uri-o-Hau Te Waipounamu/Wharekauri Region, Iwi not named Te Whānau-a-Apanui Tokomaru, iwi not named Tūhoe Tūhourangi (Te Arawa) Tūranganui a Kiwa, iwi not named Uenuku (Ruapehu, Waimarino) Uenuku-Kōpako (Te Arawa) Waikato Waikato/Te Rohe Pōtae (Waikato/King Country) Region, not further defined Waikato/Te Rohe Pōtae Region, Iwi not named Waitaha (Te Arawa) Waitaha (Te Waipounamu/South Island) Waitaha, region not known Whakatōhea Whanganui/Rangitīkei (Wanganui/Rangitīkei) Region, not further defined Whanganui/Rangitīkei Region, Iwi not named

How did you hear about us?

Please Select.. Advert Advisers on Deaf Children (AoDC) Another centre Another parent Brochure Extended Family / Whānau Facebook Hearing House Instagram Internet Other Playgroup Radio Sibling Signage Social Worker Space Staff member Unknown Walk-in Web enquiry Word of mouth

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Contact(s)

Parent(s) / Guardian(s)

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Title

Relationship

Please Select.. Aunt Brother Caregiver Cousin Dad Family Friend Godfather Godmother Grandfather Grandmother Mum Nanny Other Place Of Work Primary Guardian Secondary Guardian Sister Stepfather Stepmother Uncle Whanau

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Emergency contact(s)

Add emergency contact(s) other than Parent/Guardian – must be able to pickup your child.

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Please Select.. Aunt Brother Caregiver Cousin Dad Family Friend Godfather Godmother Grandfather Grandmother Mum Nanny Other Place Of Work Primary Guardian Secondary Guardian Sister Stepfather Stepmother Uncle Whanau

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Additional contact(s)

Do you have any additional people that can pickup your child? If so, please enter them here and press Next when you are done.

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Relationship

Please Select.. Aunt Brother Caregiver Cousin Dad Family Friend Godfather Godmother Grandfather Grandmother Mum Nanny Other Place Of Work Primary Guardian Secondary Guardian Sister Stepfather Stepmother Uncle Whanau

First Name

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Address

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Pickups prohibited by

Important – are there people who specifically cannot pickup your child? If so, please enter their details here.

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Contacts who can not pickup your child

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Title

Relationship

Please Select.. Aunt Brother Caregiver Cousin Dad Family Friend Godfather Godmother Grandfather Grandmother Mum Nanny Other Place Of Work Primary Guardian Secondary Guardian Sister Stepfather Stepmother Uncle Whanau

First Name

Last Name

Phone (Mobile)

Phone (Work)

Phone (Home)

Personal Email

Address

Same as child

Birth Date

Please note: A copy of any court document/custody order and details of any custodial arrangements will be required to keep on file for staff to sight.

Health

Child’s Doctor

Assign Doctor

Please Select.. / / // Aditya Kashyap Aditya Kashyap Aileen Wong Alet Stoltz Ali Alyabyee Ali Numan Alistair Sommerville Aliyah Namah Allan Tee Andrew Leong Andrew Stacey Andrew Stacey Andrew Wong Andrew Wong Andy Watt Andy Watt Anju Yogakumar Any Avon Medical Stratford Bakerfield Medical Bakerfield Medical Centre Bakerfield Medical Manukau Bakersfield Medical Centre Bam Abraham Beachlands Medical centre Belinda Luie Bhuana Patel Botany Junction Clinic Botany Junction Doctors Botany Junction Medical Botany Junction Medical Centre Botany Junction Medical Centre Botany Junction Medical Centre Botany Town Centre Medical Bruce Page Bryan Thompson Bushra Kadhim Carlos Carlos Lam Carlos Lam Yang Carlos Lam Yang Catherine Lu Celina Xiao Celine Lous Chan Chapel Rd Doctors Chris Naughton Chris Naughton Christine Lipyeat Christopher Naughton Cliff Ah Kit Colin Bennett Colin Chin Crawford Medical Centre Daniel Daniel Wu Dannemora Medical Centre David Chon David Chou David Wong David Wu David Wu Dawson Rd Medical De Markus Hawkins Dennis Lee Dexter Loos Dexter Loose Dong Mei Zhang Dongmei Zhang Dr Dr Dr A Kashyar Dr A Patel Dr A V C Yau Dr Abrahams Dr Ahmed Kareem Dr Ahmed Kareem Dr Aileen Dr Aileen Wong Dr Alan Tee Dr Alex DR Alex Stotlz Dr Alex Williams Dr Ali Al-Noman Dr Allan Tee Dr Andrew Dr Andrew Chan Mow Dr Andrew Grobler Dr Andrew Wong Dr Ang Dr Anna Dr Anshu Sharma Dr Anthony Yau Dr Ayad Dr B Page Dr Ban Abraham Dr Carlos Dr Carol Lam Yang Dr Carol Lam Yang Dr Celia Xiao Dr Chandra Jayaram Dr Chin Dr Choola Dr Christoper Gross Dr Cynthia Mcgreggor Dr D Mutthuvel Dr D Renata Dr Daniel Calder Dr Daniel Wu Dr David Rowe Dr Dayasingh Dr Delinka Heltiarach Dr Denis King Dr Devarajah Dr Doo Dr Eileen Sables Dr Eileen Wong Dr Elaine Ho Dr Fiona Shepard Dr Fiona Sheppard Dr Gary Wu Dr Gopi Nayar Dr Graham Whitney Dr H Gao Dr Hamid Al-Bahadly Dr Hamid H Al Bahadly Dr Hane Dr Heena Desai Dr Herman Wong Dr Herman Wpmg Dr Hine Lutui Dr Hong Kong Dr Hong Kong Dr Hou Dr Hou Dr Huang Dr Hubert D’Cruize Dr Hurbert Dr Husain Dr Hussain Dr Hyland Dr J Abraham Dr J Mansour Dr Jack Lin Dr James Te Whare Dr janan Dr Janan Mansour Dr Jayani Kannangara Dr Jayani Kannangaria Dr Jayani Kannaugara Dr Jeremy West Dr Jing Dr Jing Dong Dr Jing Dong Dr Jing Dong Dr Joe Williams Dr John Dr John Dr John SS Dr John Abraham Dr John Abraham Dr John Ambraham Dr John Kyle Dr John S Ng Dr Julie Cao Dr Juliet Dr K A Leow Dr K Ward Dr Kareem Dr Karen Chung Dr Katherine Martin Dr Kaur Dr Kenneth Tong Dr Khadder Aweidah Dr Kidd Dr L Ashby Dr L Wright Dr Leow Dr Lilly Liu Dr Linley Murray Dr Lisa Fuller Dr M Lowe Dr Manning Dr Mansour Dr Mansour Dr Marcus Hawkins Dr Marcus Hawkins Dr Markus Hawkins Dr Martin Dr Martin Dr Michael Wah Dr Mick Easton Dr Mokesh Raj Dr Murray Dr Mushfiq Ahmed Dr Muthurel Devraj Dr Nagi Dr Naughton Dr Needa Dr on Call Dr on Call Dr on Call Dr on Call Dr on Call Dr Ooi Dr Oruba Khalil Dr P Renata Dr Parmod Galgali Dr Parr Roger Dr Patel Dr Pervin Dala Dr Peter Dr Peter Oai Dr Peter Oi Dr Peter ooi Dr Peter Ooi Dr Peter Ooi Dr Peter Ooi Dr Peter ting Dr Peter Vincent Dr Phillipa Johnston Dr Pieter Vosloo Dr Pieter Vosloo DR Pieter Vosloo Dr Quero Dr R Palmer Dr Raj Dr Rajneesh Sharma Dr Rama Dr Rama Velalagan Dr Ranchod Dr Randall Sturm Dr Ray Khoo Dr Ray Khoo Dr Renee Greenmain Dr Renee Greenman Dr Richard Ruddell Dr Roger Donald Dr Rowe Dr S Kaul Dr S Salih Dr Sahar Bahnam Dr Salam Salih Dr Salem Dr Salim Salie Dr Salim Salih Dr Salim Salih Dr Santa Cruz Dr Sara Jayne Petersen Dr Sarah Smeeton Dr Sara-Jane Dr Schaffer Dr Selva Kumar Dr Selva Selverkumar Dr Selva Slevakumar Dr Selvakumar Dr Shirley Minsi Xu Dr Sigh Dr SilvaKumar Dr Sivagumar Dr Sonia Dr Sonia Kamdar Dr Stephanie Nam Dr Sturm Dr Sue Tutty Dr Sunil Roy Dr T Khellar Dr Tang Chang Dr Tanvir Kaur Dr Teresa Di Bartoli Dr Terisa Dr Theresa Khella Dr Therese Khella Dr Therese Khella Dr Tony Chang Dr Travis Kaur DR V D Bergh Dr V Settu Dr V Thakur Dr Vijay Dr Vivek Patel Dr W Angus Dr Wang Dr Wen Chen Dr Wen Chen Dr Wen Chen Dr Wen Chen Dr Williams Dr Wong Dr Wright Dr Wright Dr Young East Tamaki Heaalthcare East Tamaki health East Tamaki Health Care East Tamaki Health Care East Tamaki Health Care East Tamaki Health Care East Tamaki Health Care Otara East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare East Tamaki Healthcare Chapel East Tamaki Medical Centre Dannemora Elaine Ho Elaine Ho Elaine Ho Ellerslie Medical Centre Emah Fadel Faye Clark Fiona Ross-Taylor Fiona Shepherd Flatbush Medical Centre Frank Gilcrest Gary Wu Grace Wang Grace Wong Graham Whitney Grant Cavit Healthcare East Tamaki Healthcare East Tamaki Herman Long Herman Wong Highland Park Medical Centre Hillsbourough Medical Centre Hinamaha Lutui Hine Litui Hong Kong Surgery HongKong Surgery Isabella Chong Isabella Chong Ivan Conel Janan Mansour Janan Mansour Jayam Kannagara Jayani Kannangara Jeffrey Wong Jeong K Park Jing Cao Jing Dong John Abraham Jonan Jonathon Wong Julie Cao Julie Cao Julie Caw K Patel Kevin Gabriel Kulvant Singh Langimalie Clinic Linley Murray Lionel Wright Lorraine Forbes Lynley Murray Lois Paton Madhu Nagi Malcolm Long Mangere Family Drs Manukau Accident & Medical Manukau City Accident & Medical Centre Manukau Medical Associates Manukau medical centre Marcus Hawkins Marcus Hawkins Marcus Stone Mark Arbuckle Mark Arbuckle Mark Young Mary Hung Michael Morrison Michael Song Millhouse Drive Medical Centre Mohinda Pal Singh Mohinder Pal Singh Mohinder Pal Singh Mokesh Raj Mt Wellington Family Health Muller Mushfiq Nalini Patel Neera Surendran Nirmal Singh none One care medical centre Onehunga Medical Centre Otara Union Health Centre Pakuranga Medical Papatoetoe Family Doctors Park Jung moon Parveen Patel Peter Guy Peter Ooi Peter Ooi Peter Sandin Peter Vincent Phillipa Johnston Pramod Galgali Primla Khar Prudence Waters PS Naagi R. Coleman Radius Medical Centre Radius Ti Rakau Raj Rajneesh Sharma Rajneesh Sharma Richard Bosfield Richard Kenner Richard Mercer Richard Ruddell Richard Wong Roselands Rosie Branovich Rowena Poole Samantha King Sandiya Chunilal Sara Smeeton Sarah Sarah James Sarah Jane Sarah jane Peterson Schaffer Scott McLaren Seddon Street Medical Centre Selva Kumar Selva Kumar Selva Selvakumar Siva Vasanthan Sonia Kamdar Stephanie Nam Steve Kara Su Yin Kaur Suyin Keur Suyin Kour T Booth Tana Fishman tba Teresa Booth Teresa Di Bartolo Teresa Di Bartolo the Doctors The Doctors The Local Doctors Theresa Khella Theresa Khella Theresa Khella Therese Therese Khella Tony Chang Trevor Young Tuakau Medical Centre Ursula McCrann Vijay Satendra Vitt Hempstapatt Wai Health Walter Muller Wen Key Chen Wen Chen Wen Chen Wen Chen Wendy Chen Yi Ming Wang Yimin Wang Yimin Wang Yimin Wang Yiming Wang Yiming Wong Yoga Kumar Yoga Kumar Add New

Health

Childhood Diseases/Diagnosis

Allergies

To what period / stage is your child fully immunised up to ?

Does Not Want Immunisations

 

Special Diet

Medicines

Category I Medicines

A category (i) medicine is a non-prescription preparation (such as arnica cream, antiseptic liquid, insect bite treatment) that is not ingested, used for the ‘first aid’ treatment of minor injuries and provided by the service and kept in the ‘first aid’ cabinet.
Note: The service must provide specific information (including brands names) about the category (i) preparations that will be used.

Category III Medicines

To be filled in if your child requires medication as part of an individual health plan, for example for an on-going condition such as asthma or eczema etc. and is for the use of that child only.

Permissions

Permissions

Please indicate below whether you give permission for your child to:

Can Attend Walks

Can Attend Walks

Can Be Taken To Medical Centre

Can Be Taken To Medical Centre

Can Use Image For Planning

Can Use Image For Planning

Can Use Image For Study

Can Use Image For Study

Can Use Image For Facebook

Can Use Image For Facebook

Can Use Image For Newsletters

Can Use Image For Newsletters

Can Use Image For Notices

Can Use Image For Notices

Can Use Image For Newspaper

Can Use Image For Newspaper

Can Use Image for Playground

Can Use Image for Playground

Special

Special

Enrolment

Enrolment

× Child has to be enrolled for a minimum of one day.

× Please choose the dates and days below. Note the service may require you to enrol a certain number of days.

Start date

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Mon Session

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Sat Session

Sun Session

STATUTORY HOLIDAYS/ TERM BREAKS

This enrolment agreement is inclusive/exclusive of school term breaks. If your service is open on Statutory Holidays, parents need to confirm enrolment for each individual statutory holiday. Treetops ELC Botany Junction is open on the following public holidays if they fall on a weekday. Please tick the days you wish your child to be specifically enrolled for:
New Year’s Day	Easter Monday	Labour Day
Day after New Year’s Day	ANZAC Day	Christmas Day
Waitangi Day	King’s Birthday	Boxing Day
Good Friday	Matariki	Local Anniversary Day

Enrolment Uploads

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