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Canada The BUSY School Home
MŌ
He mōhiohio:
- He mōhiohio mā ngā mātua
- He mōhiohio mō ngā hoa mahi rangapū
Campus
He kōrero anō
Admissions
- Registration Process
- Register
He Rongo Kōrero
ME WHAKAPĀ MAI

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Ī-mērā
This field is for validation purposes and should be left unchanged.
APPLICATION FOR ENROLMENT
Student's Name*
Date*
DD slash MM slash YYYY
Year student is applying to start:*
Grade*
Select the Campus student is applying for:*
Please note that your application may not be processed until you have provided the below documentation.
- Birth Certificate or Passport
- Visa documentation (if applicable)
- Legal documents/ Court orders (if applicable)
- Immunisation records
- Most recent school report (including any adjustments/ support provided at previous school)
- Medical documents (eg; specialist and/ or any diagnostics, paediatric, educational, psychological or other reports applicable to the Students care and education)
Please attach relevant files here.
Drop files here or
Accepted file types: jpg, jpeg, pdf, png, doc, docx, , Max. file size: 20 MB.
STUDENT DETAILS
Student’s Legal First Name:*
Middle/Other Names:
Student’s Legal Surname:*
Preferred Name:
Date of Birth:*
DD slash MM slash YYYY
Student’s Phone Number:
Gender*
- Male
- Female
- Ko tētahi atu
Preferred pronouns (he/him, they/them, she/her)
Student's Email Address:
Student's Home Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student's Postal Address: (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Religion: (if applicable)
Shirt Size:
Is a language other than English spoken at home?*
- Yes
- No
If yes, please specify
Does the student speak an Indigenous Language?
- No
- Traditional Language
- Indigenous English
- Creole
Is the student of Indigenous Decent?*
- Yes
- No
Country of Birth:
Citizenship:
PREVIOUS SCHOOL DETAILS
Current School (Write N/A if not applicable):*
Grade/s enrolled:
Previous Schools (Write N/A if not applicable):*
Grade/s enrolled:
Please describe the student’s current schooling situation: (eg suspensions, expelled, school refusal, truancy, bullying, struggling at school, etc)*
Previous adjustments made in school:
MEDICAL DETAILS
Does the student have Private Health Insurance?
- Yes
- No
If yes, who is the insurer?
Does, or has the student ever suffered from Asthma?
- No
- Yes, mild
- Yes, moderate
- Yes, severe
If yes, please complete or have your doctor complete the appropriate management plan and provide a copy to BUSY School.
Does, or has the student ever suffered from Diabetes?
- No
- Yes
Last Diabetic episode date:
DD slash MM slash YYYY
Treatment:
Does, or has the student ever suffered from Epilepsy?
- No
- Yes
Last Epileptic episode date:
DD slash MM slash YYYY
Treatment:
Does, or has the student ever suffered from Allergies?
- No
- Yes (Including penicillin and other drug/food allergies)
- Anaphylaxis
If yes, provide details below:
Details of allergies (include specific allergy and reaction):
Last allergic episode (please describe reaction and treatment):
Does, or has the student ever had any other medical condition?
- No
- Yes
If yes, please provide more information:
Any other known childhood diseases, operations or major injuries?
Any other known childhood diseases, operations or major injuries?
Does the student take any regular medication? (prescribed or over the counter)
- No
- Yes
If yes, please provide details and dosage
Will the student require any medication to be taken at school? (regular or occasional)
- No
- Yes
If yes, please provide details and dosage
Has the student received the full program of standard childhood immunisations? (up to current age)
- No
- Yes
If no, please list the immunisation the student has received:
Permission to administer paracetamol if needed? (dosage will be as per the box/ bottle for the students age). If ticked yes, student to provide medication with chemist label attached showing student name and dosage required. A completed Medications in School Form is also required
- No
- Yes
Students current swimming ability:
- Can't swim
- Struggles swimming
- Comfortable swimmer
- Strong swimmer
Has the student been professionally diagnosed with any of the following? (tick all that apply)
- Hearing Impairment
- Speech Language Impairment
- ASD (Autism, Asperger’s, PDD-NOS)
- Borderline Intellectual Difficulties
- Operational Defiant Disorder
- Physical Impairment
- Intellectual Disability
- ADD/ADHD
- Speech/Language Difficulties
- Conduct Disorder
- Visual Impairments
- Social/Emotional Disorder
- Dyslexia
- Dyspraxia
- Sensory Processing
- Other, please specify below:
Ko tētahi atu
Year of initial diagnosis and next review date:
Was the student a verified student with a disability at their previous school?
- No
- Yes
If yes, what was the AIMS number?
EDUCATION NEEDS - IN CLASS SUPPORT
Has the student received adjustments to assist them to participate in schooling in their previous schools?
- No
- Yes, emotional regulation support
- Yes, behavioural support
- Yes, reading/ writing support
- Yes, mathematics support
Do you consider the student to have difficulties with learning?
- No
- Yes, anxiety that stops learning
- Yes, difficulty with verbal instruction
- Yes, difficulty with written instruction
- Yes, difficulty speaking with adults
- Yes, reading/ writing issues
- Yes, memory Issues
- Yes, attention Issues
- Yes, difficulty with Mathematics
- Yes, difficulty managing time
- Yes, difficulty organising self
- Yes, issues working with others
- Yes, difficulty regulating emotions
Has the student used special Education, Learning Support or Guidance from previous education providers?
- No
- Yes, individual Education Plan
- Yes, behaviour support
- Yes, speech therapy
- Yes, in class support
- Yes, guidance Officer Support
- Yes, reading/ writing
- Yes, support Mathematics
If you have ticked yes to any of the above please provide school reports around adjustments and support provided at previous school.
Please attach relevant files here.
Drop files here or
Accepted file types: jpg, jpeg, pdf, png, doc, docx, , Max. file size: 20 MB.

OTHER INFORMATION
With whom does the student normally live with?*
- Both parents at same address
- Mother
- Both parents at different addresses (shared parenting arrangement)
- Father
- Grandparents
- Other, please specify below
Other, please provide details:*
If living at two different addresses provide details of living arrangements (eg; Mum's weekdays, Dad's weekends)
Are there any current or historic legal orders relating to the student? (eg parenting orders or court documents)
- No
- Yes, current orders
- Yes, historic orders
Please attach files here:
Drop files here or
Accepted file types: jpg, gif, png, pdf, doc, docx, jpeg, Max. file size: 20 MB.
If yes, copies of current orders/ documents must be included with this application. Originals will need to be sighted at interview.
Is the student applying for enrolment as an Independent student?
- No
- Yes
If yes, you will need to provide either Centrelink documents or if over 18 written consent from your parent/ care giver providing consent for you to be an Independent.
Is there any other health, medical or background information we need to know about the student?
Is there any other information that you consider would be helpful in the nurture and education of this student?
FAMILY DETAILS
Please list details of biological parents as well as those who have parental responsibility for the student (eg, step-parents)
Parent/ Carer 1 - Generally the first person to contact during school hours
First Name (Parent/ Carer 1)*
Surname (Parent/ Carer 1)*
Preferred Name
Country of Birth*
Title (Mr, Ms, Mrs, Dr, etc)
Mobile Phone Number: (Parent/ Carer 1)*
Home Phone Number:
Gender:*
- Male
- Female
- Ko tētahi atu
Receive Notifications by:
- SMS
- Ī-mērā
- Mail
Email Address: (Parent/ Carer 1)*
Home Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Postal Address: (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to Student:*
Occupation:*
Work Phone Number:
Work Email Address:
Workplace/Company Name:
Partner/ Spouses Name:
Student lives with Parent/Carer 1:*
- Full-time
- Part-time
- Casual
Is a language other than English Spoken at Home?*
- No
- Yes (please specify below)
Please specify
Does the student speak an Indigenous Language?
- No
- Traditional Language
- Aboriginal English
- Creole
Are you of Aboriginal or Torres Strait Islander descent?*
- No
- Aboriginal
- Torres Strait Islander
- Aboriginal and Torres Strait Islander
Highest level of school education completed:*
- Grade 12 or equivalent
- Grade 11 or equivalent
- Grade 10 or equivalent
- Grade 9 or equivalent
Highest level of non-school education completed:*
- Bachelor Degree or above
- Diploma
- Certificate I or IV 1
- None
Occupation Group:*
See descriptions here
- 1
- 2
- 3
- 4
- 8
Is there any other information we need to know about Parent/Carer 1 or their relationship to the student? (eg contact limitations, legal orders, family issues, etc)
Parent/ Carer 2
Ingoa Tuatahi
Surname
Preferred Name
Title (Mr, Ms, Mrs, Dr, etc)
Country of Birth
Mobile Phone Number:
Home Phone Number:
Gender:
- Male
- Female
- Ko tētahi atu
Receive Notifications by:
- SMS
- Ī-mērā
- Mail
Email Address:
Home Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Postal Address: (if different from above)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Relationship to Student:
Occupation:
Work Phone Number:
Work Email Address:
Workplace/Company Name:
Partner/ Spouses Name:
Student lives with Parent/Carer 2:
- Full-time
- Part-time
- Casual
Is a language other than English Spoken at Home?
- No
- Yes (please specify below)
Please specify
Does the student speak an Indigenous Language?
- No
- Traditional Language
- Aboriginal English
- Creole
Are you of Aboriginal or Torres Strait Islander descent?
- No
- Aboriginal
- Torres Strait Islander
- Aboriginal and Torres Strait Islander
Highest level of school education completed:
- Grade 12 or equivalent
- Grade 11 or equivalent
- Grade 10 or equivalent
- Grade 9 or equivalent
Highest level of non-school education completed:
- Bachelor Degree or above
- Diploma
- Certificate I or IV 1
- None
Occupation Group:
See descriptions here
- 1
- 2
- 3
- 4
- 8
Is there any other information we need to know about Parent/Carer 1 or their relationship to the student? (eg contact limitations, legal orders, family issues, etc)

ADDITIONAL OR EMERGENCY CONTACT
Ingoa Tuatahi
Surname
Preferred Name
Home Phone Number:
Mobile Phone Number:
Relationship to Student:
Gender:
- Male
- Female
- Ko tētahi atu
Email Address:
Home Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student lives with contact:
- Full-time
- Part-time
- Does not live with
EXTERNAL STAKEHOLDERS (GUARDIAN)
Name of Organisation
Waea
Email Address:
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary contact in relation to the student:
Job title in relation to the student:
Contact number:
Email Address:
Additional Organisation Contacts: (Name, phone, job title, etc.)
Who can sign forms and documents in relationship to the student? (eg permission forms, etc)

DECLARATION
- I/we apply to have the student named in this application enrolled at BUSY Schools.
- I/we understand that this application is made without any implication that an offer of enrolment at BUSY Schools will be made.
- I/we understand that under normal circumstances BUSY Schools requires any prospective student to attend an interview with the Principal (or Principal’s representative) before an offer of enrolment can be made.
- I/we understand that to accept an offer of enrolment at BUSY Schools we must accept the school’s Terms & Conditions of enrolment as per the Enrolment Agreement and Code of Behaviour.
- I/we understand that this application may not be processed until all required documents have been provided.
- I/we declare that the information we have supplied on this form is complete, true and correct, and understand that inaccurate, incomplete or misleading information may jeopardise enrolment.
- I/we give permission for external stakeholders and specialist support teams to be contacted to support the students application.
- I/we give permission for BUSY Schools to engage with internal staff, external stakeholders, allied health and specialist support teams e.g. youth worker, psychologist and counsellors, to support and assess the students overall wellbeing.
- I/we agree to the implementation of a flexible timetable arrangement for this student at BUSY Schools to allow for employment pathways and additional education and training programs to run within their timetable.
Parent/Carer 1 Signature:*
Date*
DD slash MM slash YYYY
Parent/Carer 2 Signature:
Date
DD slash MM slash YYYY
Or, I wish to apply for an enrolment as an Independent student and will be responsible for signing all School forms and payment of all accounts.
Student Signature:
Date
DD slash MM slash YYYY
Or, signed for on behalf of the organisation that holds legal guardianship for this student.
Student Signature:*
Date*
MM slash DD slash YYYY
Name:
Position:

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Canada The BUSY School Home
MŌ
He mōhiohio:
- He mōhiohio mā ngā mātua
- He mōhiohio mō ngā hoa mahi rangapū
Campus
He kōrero anō
Admissions
- Registration Process
- Register
He Rongo Kōrero
ME WHAKAPĀ MAI

Canada The BUSY School Home
MŌ
He mōhiohio:
- He mōhiohio mā ngā mātua
- He mōhiohio mō ngā hoa mahi rangapū
Campus
He kōrero anō
Admissions
- Registration Process
- Register
He Rongo Kōrero
ME WHAKAPĀ MAI

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