Out of Zone Enrolment
ID:0 | 05/10/2022 |

Recipient: Guest
Originator: Guest
1 1. Application Information
1. Application Information
2 2. Immigration Status
2. Immigration Status
3 3. Caregiver Details
3. Caregiver Details
4 4. Caregiver 2
4. Caregiver 2
5 5. Student`s Special Learning Needs
5. Student`s Special Learning Needs
6 6. Student Health Record
6. Student Health Record
7 7. Courses
7. Courses
8 8. BYOD
9 9. Cybersafety
9. Cybersafety
10 10. The Selwyn Way
10. The Selwyn Way
* Mandatory fields | 
About Yourself

This is an application for out of zone students. If you live in our zone  please use the In Zone form instead.

Name of the person completing this form *

Email Address *

Are you in zone for Selwyn? *

Do you have other immediate family members currently or recently enrolled at Selwyn College?

What are the full name(s) of other family member(s) currently attending Selwyn College and what is the nature of relationship(s)  (i.e. sibling, cousin etc) (e.g. John Bloggs - step-sibling)

House of other family members:

I give permission for senior Selwyn College staff to discuss matters relating to my child's learning with staff at their previous school. *
Student Personal Details

Legal surname: *

Preferred Surname: *

First Name:

Middle Name

Name preferred to be known by:


Students Residential Address: Number and Street




Student Mobile:

Student email:

Date of Birth:

Incoming Year Level:

Intended start date (choose 02/02/2023 for next year): *

Country of Birth:

Country of Citizenship:

Either Birth Certificate Number or Passport Number:

Upload evidence (scan a copy of your NZ passport, NZ birth certificate etc)

Please nominate up to three ethnicities


Iwi affiliations

Please nominate up to three affiliations here, if you need more please let us know during the enrolment interview

Iwi affiliation(s):

Student Personal Details

First Language:

Previous School in New Zealand / Overseas:

School report:

National Students Number (NSN):
Immigration Status

What is your citizenship status?:

Date of arrival in New Zealand:

Permit expiry date:
Caregiver Details

Family Name:

First Name(s):


Relationship to Student:

Home Phone:

Mobile Number:

Work Phone:



Name of Employer/Company:

Please tick the items that apply to Caregiver 1:
Caregiver 2

Enter details for a second caregiver, if residential details are the same as for caregiver one please leave these fields blank.

Family Name:

First Names:


Relationship to student:

Do you live with this student?

If not living with student - residential address: Number and Street


Post code:

Home Phone:

Mobile Phone Number:



Name of Employer/Company:

If this caregiver does not live with the student, do you require mail concerning student welfare to be sent to both caregivers?

Please check the items that apply to Caregiver 2:

Do you wish to have fees and charges split between caregiver 1 and 2?

Please upload any relevant evidence of caregiver arrangements (e.g. custody documents or court orders).
Student's Special Learning Needs

Please describe any special learning needs:

Comments / Sensitive Data. Please give any specific information that we should be aware of in relation to caregiver/custody arrangements or any other information that may affect this student's learning.
Student Health Record

This information is required to help us care for the student in times of illness or in emergencies. While this information is strictly confidential, it may be necessary for the safety of the student, or others, to inform relevant staff or medical personnel of medical conditions. Teachers may be informed of conditions affecting the student's education progress.

You will be asked to complete a more detailed medical form once your enrolment has been accepted. For now, please provide us with these initial details.

Medical condition(s):

Family Doctors Name:

Doctors Phone:

Dentist name:

Dentist Ph: