Student Surname: Student First Name: Hamilton Girls high school for 2018

Transcription

1 Student Surname: Student First Name: OFFCE USE Enrolment No: Entry Date: SAPENS FORTUNAM FNGT Hamilton Girls high school Sonninghill Hostel Application for Admission 2017 for 2018 Please complete all pages in this document and return by delivering to Sonninghill Hostel or post to: Director of Boarding Sonninghill Hostel P O Box 512 Waikato Mail Centre 3240

2 SAPENS FORTUNAM FNGT hamilton girls high school Application For Admission To Sonninghill Hostel This form is to be used to apply for immediate entry or entry next year. Student Details (please print) Family Surname: Name jfirst Name: Date of Birth: Preferred Name Street Address: City: Current School: Current Year Level: Calendar Year Entry is Sought: Mother s nformation Mobile Phone: Home Address/ Postal Address: Family Occupation: Name City: Father s information Mobile Phone: Home Address/ Postal Address: Family Occupation: Name City: Details of person to whom nvoices will be addressed (if different than above): Mobile Phone: Home Address/ Postal Address:

3 SAPENS FORTUNAM FNGT hamilton girls high school Application For Admission To Sonninghill Hostel Emergency Contact if Parent/Caregiver is unavailable: Relationship: Names of sisters who have attended, are attending or may attend in the future: Transport Nearest secondary school from home Distance of nearest secondary school from home s a school bus available to the nearest secondary school? YES NO f yes, how far is it from your home to the nearest pick-up point? What time would your daughter leave home to catch the bus? What time would she return home? Are bus changes required en route? YES NO f yes, how many? s transport to and from Hamilton available on a daily basis? YES NO Please give additional information regarding special circumstances, including transport, on an additional sheet and attach to this application. Additional information required: The health form should be completed by yourself and your family doctor and forwarded with this application. The school report should be passed to the Principal of the school your daughter is currently attending. The school will forward this directly to Sonninghill Hostel. A personal profile to be hand written by your daughter (without assistance) is to accompany this application. t should cover such things as her family, her interests, her aspirations and any other ideas and thoughts she may like to share. Maximum length one side A4 sheet. Please also include a photo of your daughter. Any custodial arrangements or Court Orders relating to the Guardianship of the applicant are attached. As parent/legal guardian, wish to enrol the above named student at Sonninghill Hostel. declare that am the parent/legal guardian of the applicant and that all information contained in this application is correct. Any differences of information given will be communicated to the Board of Trustees to enable the case to be reviewed. Signature Date

4 SAPENS FORTUNAM FNGT Confidential Health File: Part One Please notify the school in writing of any changes to your daughter s health information. All health information is protected by the Privacy Act Family Surname: Name Firstname: Family Date of Birth: Name Doctor: Dentist: Phone: Phone: Medical Conditions (please tick all conditions your daughter has previously or currently suffers from) Asthma Fainting Travel sickness Bleeding disorder Hearing Sleep walking Cancer Heart conditions Allergies Diabetes Hepatitis Medicines Epilepsy HV Food Eyesight Kidney nsect bites/stings Menstrual problems Other (specify) Please provide any additional details here: Does your daughter have any special dietary needs (please tick) Yes No f Yes, please specify s your daughter taking any regular (i.e. daily) medications? Yes No f yes, please provide details: Has, or is, your daughter treated for and/or taking medication for: Depression Yes No Anxiety Yes No Panic Attacks Yes No Would you like a School Counsellor to make an appointment with your daughter? Yes No Please provide an action plan from the applicants Doctor for asthma/allergies/anaphylaxis if relevant: When was your daughter s last tetanus injection? Name any specialist attending to your daughter: Tick the relevant box if your daughter is vaccinated against the following and include copies of immunisation records: Measles, Mumps, Rubella (MMR) Diphtheria, Tetanus, Pertussis, Polio, Hep B, nfluenza (DTaP-PV-HepB/Hib) Pneumococcal Vaccine Tetanus, Pertussis, Diphtheria (Boostrix) Human Papillomavirus (HPV) nfluenza Vaccine

5 SAPENS FORTUNAM FNGT Confidential Health File: Part Two Please notify the school in writing of any changes to your daughter s health information. All health information is protected by the Privacy Act Should you have any concerns regarding the health of your child and wish to speak with the School Nurse, please contact the school. Please provide any other information you believe may be helpful when assessing and treating the wellbeing of your daughter: n the event of acceptance to Sonninghill Hostel give permission for my daughter to be: (please tick yes or no) Yes No Treated by a Doctor, Nurse or First Aider arranged by Sonninghill Hostel in the parents/ caregivers absence Yes No Given routine shelf medication as required by the Hostel Duty Boarding Manager (e.g. Paracetomol, buprofen, Antihistamine cream or tablets, Arnica, throat lozenges) Yes No Taken to Anglesea Clinic or Accident and Emergency if an emergency arises. Costs incurred to be met by parents/caregivers Medication Acknowledgement Yes No agree that all medicines being taken by my daughter will be labelled, fastened and given to a Duty Boarding Manager who will oversee and record administration of correct medication. Signed (parent/caregiver) Date Signed Parent/caregiver Name Student Name Date Signed

6 SAPENS FORTUNAM FNGT Confidential Report from Current School To the teacher of (Student s Name) The Board of Trustees would be grateful for your co-operation in providing the following information concerning a student at your school who has applied for a position at Sonninghill Hostel and for entrance to. My assessment of the above student s achievement levels at Year is: Science Mathematics Reading Written language Spoken language Sporting ability High Medium Low Personal Qualities Consistently Usually Sometimes Positive attitude to learning Positive relationship with others Ability to set and achieve own goals Positive attitude to school Special academic abilities: Special academic needs: Cultural interests/abilities: Musical interests/abilities: Sporting interests/abilities: Additional comments that may assist the Selection Committee: Class Teacher.. Principal.. Date.. School.. Please return this form directly to: Director of Boarding Sonninghill Hostel P O Box 512 Waikato Mail Centre 3240 Or via to: director@sonninghill.school.nz

7 SAPENS FORTUNAM FNGT Sonninghill Hostel Application Checklist Please tick below all documents enclosed with this application and return this checklist with your documents. Application Form Confidential Health File Form mmunisation Records Confidential School Form Personal Profile, handwritten by Applicant Photo of Applicant f relevant: Custodial arrangements or Parenting Orders Anaphylaxis Action Plan from Doctor