Preference Enrolments:

The close off date for applications for enrolment for 2020 is 5 July 2019. The following forms must all be returned completed with your application. Applications can only be accepted when all forms are completed:

Application for enrolment

Code of acceptable use of computers form

Local trip consent form

Permissions form

Preference certificate

Attendance dues agreement form

Copy of the student’s birth certificate if born in NZ, or if born outside NZ residency or citizenship papers

It is essential that students enrolling as preference students include a copy of their preference certificate with the enrolment form. If you do not have a current preference certificate, you will need to use the enclosed Certificate of Preference form or obtain one from your local Parish Priest or Ethnic Chaplain. We will contact you in due course to advise you of your acceptance and to arrange for subject selection. Non-Preference Enrolments: The following forms must all be returned completed with your application. Applications can only be accepted when all forms are completed:

Application for enrolment

Code of acceptable use of computers form

Local trip consent form

Permissions form

Attendance dues agreement form

Copy of the student’s birth certificate if born in NZ, or if born outside NZ residency or citizenship papers

We will contact you in September to arrange an interview before deciding on acceptance of enrolment.

St Bernard’s College Enrolment Procedures

To assist in Completing the Enrolment Form

All families are different, it is important we receive the correct infor-mation that relates to your family situation. If your son lives between two different homes, please list both address-es and contact numbers. Please also attach any relevant information with regards to legally bind-ing arrangements; these may include court orders, formal custody agreements or any other information you deem important. In all circumstances, your privacy will be protected. If you have any enrolment queries, please contact the school secretary Nicola Grant on 560 9250 or office@sbc.school.nz

ST BERNARD’S COLLEGE APPLICATION FOR ENROLMENT

FULL NAME OF STUDENT(as per Birth Certificate)

First name(s): _____________________________ Last name: _______________________________ Preferred Name (eg Bill)______________________

YEAR LEVEL for 2020 (please circle)

7 8 9 10 11 12 13 Date of Birth: / / 20 (Ministry requirement: copy of student’s birth certificate / passport attached)

Home Address (where student is living) _______________________________________________________________________

_______________________________________________________________________

Home Phone: _________________

Previous School: ——————————————————————————————————————————————— Is this student under a stand down or suspension, or has he been expelled or excluded from his last

school? Yes No (please tick)

Catholic Baptism: Yes No (please tick) Confirmation: Yes No (please tick)

Which Catholic Parish is the family connected with OR if non-Catholic please state Religious affiliation (if any) ___________________________________________________________________________________

PREFERENCE STUDENT Yes No (for office use only) ………………………………….(Principal)

ETHNICITY: (please tick those applicable)

NZ European Other European Please state______________________

NZ Maori Pacific Island Please state______________________

Iwi Affiliation(s) (please detail below) Asian Please state______________________

__________________________________ Other Please state______________________

__________________________________ Language spoken at home: ______________________

RESIDENCY STATUS (please tick)

New Zealand/Australian Citizen

New Zealand/Australian Resident

Other (please state)

If not born in New Zealand please provide evidence of eligibiliity to study in New Zealand (permanent residency or citizenship)

Please note: The school communicates with parents via email. It is essential that the school is provided with a valid email address that you check regularly. (Please print clearly)

__________________________________________________________________

Are you the son of a St Bernard’s College Old Boy? YES / NO

Do you have a brother/s here? Name/s

This is the caregiver order we will contact if there is an emergency

Primary Caregivers: Living with son Access to Son Shared Care

Secondary Caregivers: Living with son Access to Son Shared Care

EMERGENCY CONTACT (NOT TO BE A PARENT/CAREGIVER AND MUST LIVE IN WELLINGTON) SIGNATURE AND DECLARATION (TO BE COMPLETED BY ALL APPLICANTS) I / We hereby agree to pay ATTENDANCE DUES as determined by the Archdiocese of Wellington and the various SCHOOL COSTS as determined by the Board of Trustees. I / We agree to ensure that this pupil will wear the CORRECT COLLEGE UNIFORM, and adhere to the SCHOOL RULES and CODE OF CONDUCT (details of these are provided on our website). I / We accept as a condition of enrolment that this pupil will participate in the general College programme that gives St Bernard’s College its Catholic character. I / We will be happy to assist where I / we can to belong to the College community. I / We authorise St Bernard’s College to ask the previous school of this pupil for any relevant school records.

Parents’/Caregivers’ signatures: ………………………... …………………………… Dated …………………..

Mr / Mrs / Ms / Miss

Full Name Relationship to student (e.g. mother/father)

Address: Cell Phone: Work Phone:

Occupation: Email:

Mr / Mrs / Ms / Miss

Full Name Relationship to student (e.g. mother/father)

Address: Cell Phone: Work Phone:

Occupation: Email:

Name: Relationship to student:

Phone: Cell Phone: Work Phone:

Mr / Mrs / Ms / Miss

Full Name Relationship to student (e.g. mother/father)

Address: Cell Phone: Work Phone:

Occupation: Email:

Mr / Mrs / Ms / Miss

Full Name Relationship to student (e.g. mother/father)

Address: Cell Phone: Work Phone:

Occupation: Email:

Surname:____________________First Name/s: _____________________

At St Bernard’s College we wish to know of any health/learning issue which may affect your son’s attendance, learning and/or development This information helps us to plan accordingly. (Please circle any that are relevant) Asthma Skin Mental Health Aspergers

Hearing Epilepsy Drugs/alcohol Autism

Vision/glasses Allergies Smoking Dyslexia

Behaviour Headaches/migraine ADHD Anxiety

Depression Irlen Syndrome

Any other information or health condition — Please be specific: ________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________ Does your child take any regular or emergency medicines? YES / NO Please list _____________________________________________________________________________ It is important for us to know if your child has a condition that requires an Emergency Action Plan that needs to be managed. Examples include but are not limited to - severe allergic reaction (Anaphylaxis) Do you already have an Emergency Action Plan? (please attach copy)

Family Doctor’s Name__________________________________________________ Dentist_____________________________________________________________

Any other health condition requiring emergency first aid care?

Yes No (please tick) Details: ————————————————————————————————————————

————————————————————————————————————————

————————————————————————————————————————

STUDENT HEALTH and LEARNING INFORMATION (Please complete and return)

PANADOL: Do you give permission for Panadol to be given to your son should he require it? YES / NO

PRIVACY STATEMENT

St Bernard’s College collects the information on this form to:

enrol your child at school

assess the educational needs of your child

ensure the school gets the correct resources from the Ministry of Education for your child.

We collect and use your child’s information in accordance with the Privacy Act. We send some of your child’s information to the Ministry of Education, Catholic Schools Board and other education and health agencies. We will not provide your child ’s information to ay other people or organisations without your authorisation, unless needed by law.

Youth Service

The Ministry of Education shares your address and phone number information with the Ministry of Social Development (MSD) as part of the Youth Service initiative. Youth Service identifies young people who may have difficulty finding future employment, training or further education. Youth Service uses the contact information to find these young people and support them into education or training when they leave school.

Accessing or changing your information Please contact us if you want to view or change your child’s information. St Bernard’s College does not need parental consent to send roll return and ENROL information about their child to the Ministry. We will not send all the data we collect to the Ministry. For example, we do not send information about emergency contacts or custody arrangements in the roll returns.

Code of Acceptable Use of ICT Students who wish to use information and communication technology (ICT) at St Bernard’s College must agree with this code which remains valid for the entire period the student is enrolled. St Bernard’s College students are expected to be safe and responsible in their use of ICT. In order to access ICT at St Bernard’s College all students must agree to:

ensure that the use of ICT and mobile devices at school is related to the genuine curriculum and education-related learning activities

recognise the authority and responsibility of staff to direct, permit, restrict and authorise the use of ICT at school and act accordingly

not use ICT to harass, bully, demean or hurt others

exercise appropriate care for the stewardship of the ICT property and the resources of the school and of other people

harness our ICT expertise and skills to support and enhance the work of the school, rather than engaging in destructive activities such as hacking, uploading viruses, damaging infrastructure, distributing spam or deleting the work of others

avoid allowing ICT-related distractions to detract from our learning or the learning of others at school

not plagiarise, ensuring that they properly reference the work of others

protect the privacy, confidentiality and the dignity of individuals by not disclosing, using, distributing or publishing information about individuals in any way that may cause them harm

not utilise the identity, accounts, passwords or confidential details of other people

protect our relationships by not accessing, sharing, sending or publishing material that is hurtful, offensive, inappropriate or false

not use ICT to photograph, video or record people in the school context, or publish or distribute those recordings, without the express permission of the supervising teacher

take responsibility for reporting inappropriate usage of ICT in the school.

Failure to comply with the terms of this agreement may result in one or all of the following consequences:

Loss of ICT access Disciplinary action Requirement to pay for loss or damage In certain cases, matters could be referred to the police.

Parents are asked to support the college by signing and returning this document.

STUDENT: I understand and will abide by this Code of Acceptable Use of ICT by students at St Bernard’s College. ......................................................................... Student Name (please print) ......................................................................... Student Signature ............................... Date PARENT/CAREGIVER: I have read this Code on Acceptable Use of Computers by Students and accept that St Bernard’s College has the right to discipline students who abuse its ICT.. ........................................................................... Parent/Caregiver Name (please print) ........................................................................... Parent/Caregiver Signature ................. Date

Local Trip Consent Form During your son’s time at St Bernard’s College, he will enjoy many educational outings and off-site visits. It is a legal requirement for us to identify risks to health and safety when taking our students off-site. A formal risk assessment is required before any trip is given approval by the college’s Senior Leadership Team. This risk assessment prepared by the trip organiser details aspects such as:

● the reason or justification for the trip ● staff supervision details ● transport arrangements ● medical details ● contact details ● associated risks and how these will be mitigated.

Requiring an individual consent form from each parent for each trip causes significant issues – particularly when relying on the boys either to give you the details or to return the consent form to their teacher.

Therefore, we are asking you to sign a blanket off-site day trip consent form to cover your son’s time at the college. This has become common practice in many colleges. This blanket

consent may be used to cover local visits (within 50km radius of the College), games trips and other visits that will take place during normal school time under the supervision of school staff. Detailed information concerning the aim of the visit, the destination, dates and timings will be provided in writing (usually by email) to you prior to any trip. You will, of course, be able to request further clarification and/or refuse consent for any particular trip but would need to instigate this action yourself.

Risk assessed to be greater than that associated with the average family activity will require separate permission to be given.

If you have any questions please feel free to contact me on dsefton@sbc.school.nz or any member of the College Senior Leadership team.

Day Trip and Local Visit Consent

I give my son______________________________________ (use first and last name) consent to attend off-site day-trips that are organised by the college as detailed above.

I further understand that I will be notified of each trip that my son will be involved in and that I will be given the opportunity seek further clarification of details and/or withdraw my consent in writing if I wish to do so.

I understand that a risk assessment will be conducted for each trip my son is involved in and that the college leadership will give approval before that trip can occur.

Signed: _______________________________________ Date _________________________

St Bernard’s College Permissions

Permission for the school to use photos, videos, and electronic images of your son or examples of his work.

I give permission for St Bernard’s College to use photos and electronic images and/or examples of my son’s work in school publications including the newsletter, annual report, yearbook, production videos and publicity material, press releases, advertising and the school websites. Permission to send communications by text and email.

I give St Bernard’s College permission to send communications to phone numbers, email addresses and/or by other electronic media to addresses I supply to the college. The permissions given above remain in force unless revoked by me in writing to the Principal. Student’s Name Year Student’s Signature Parent/Caregiver Name Parent/Caregiver Signature Date

Attendance Dues Agreement

BETWEEN: The Roman Catholic Archbishop of the Archdiocese of Wellington, ("the Proprietor")

who is the owner of ___________________________________________(“the school”)

AND: The following Parents/Caregivers

Complete all sections of this form – print clearly in capital letters Existing Attendance Dues A/c No:

(Leave this number blank if this is your first student to be enrolled in a Catholic school in the Wellington Archdiocese)

Details Parent/Caregiver 1 Parent/Caregiver 2

Title

Surname

First Names

Relationship to student

Residential Address

Post code

Phone (day)

Phone (mobile)

Email address

WHO have enrolled the following student(s) at the school:

First and middle names of student(s)

Surname of student(s) Gender M/F

Pref Y/N

Year level

Start Date

Acknowledgement

1. I acknowledge that I have read and understand this Attendance Dues Agreement and agree to comply with its terms and conditions.

2. I also agree to advise the Archdiocese of Wellington Dues team in writing if my/our circumstances change. 3. I accept responsibility for the payment of the attendance dues charged by the proprietor.

--------------------------------------------- ---------------------------------------------------- ------/------/20---- Signature of parent/caregiver 1 Name (please print) Date

--------------------------------------------- ---------------------------------------------------- ------/------/20---- Signature of parent/caregiver 2 Name (please print) Date

1.0 Introduction

1.1 The Proprietor has entered into an Integration Agreement with the Minister of Education in respect of the school. The Integration Agreement, made pursuant to the Private Schools Conditional Integration Act 1975 (“the Integration Act”), provides that the Proprietor may enter into an agreement with the Parents or other persons accepting responsibility for the education of a child providing that, as a con-dition of the enrolment or attendance of the child at the school, the Parents or other persons shall pay attendance dues.

1.2 Attendance dues are used by the Proprietor for the purposes specified in Section 36 of the Integration Act.

2.0 Agreement to pay Attendance Dues

2.1 By signing this Attendance Dues Agreement, you are agreeing that, as a condition of enrol-ment of the student(s) at the School, you will pay all attendance dues charged by the Proprietor in respect of the student(s).

2.2 Each year, the Proprietor will issue you with an invoice for all attendance dues payable in respect of the student(s) and you agree to pay the invoice in full by the date stipulated in it (unless you have previously made alternative payment arrangements with the Proprietor).

2.3 If you default in paying any attendance dues then any recovery costs incurred by the Proprietor will be an additional expense to be paid by you (and will be added to the total attendance dues owing and payable by you).

2.4 You are also acknowledging that the Proprietor: (a) May increase attendance dues from time to time provided such increases are within the maxi-

mum attendance dues permitted to be charged by the Ministry of Education; (b) Is likely to review and (if necessary) increase the level of attendance dues payable at least an-

nually.

3.0 Use of Personal Information Provided

3.1 The Proprietor is committed to respecting your privacy by protecting the information you voluntarily provide. The information will be held and stored securely by the Archdiocese of Wellington (ADW), which administers attendance dues on behalf of the Proprietor.

3.2 Information entered into the ADW database is protected using industry standard technology such as encryption and password protection. Information is only accessible to personnel who need access to do their work and will be used primarily for administration of attendance dues.

3.3 Information about outstanding attendance dues may be shared by ADW with the Proprietors and per-sonnel of other Catholic Schools attended by members of your family, and with their attendance dues collection agents.

3.4 Information voluntarily provided by you to the Proprietor may also be shared with your Parish for the purpose of supporting the student(s) formation of the faith and practices of the Catholic Church.

3.5 The information will not be shared with any other party without your permission. 3.6 You can ask for a copy of any personal information the proprietor holds about you, and ask for it to be

corrected if you think it’s wrong. If you would like a copy of your information, or want to have it cor-rected, please contact ADW.

Once completed, this form, and all other enrolment information required by the Proprietor for the purposes set out in clause 3.0 of this Attendance Dues Agreement must be returned to the school.

ADW Contact Information:

1. The ADW office is at the Catholic Centre, 22 Hill Street, Wellington 6011 2. Postal address: “Attendance Dues” P.O. Box 1937 Thorndon, Wellington 6140 3. Telephone: 0800 462 725 4. Email: dues@wn.catholic.org.nz 5. Text: 021 0890 7902

ADW dues team to complete this sec-tion:

School Number:

Enrolment Number:

Account Number: