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Year* Select Year 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 Year Level* Select Year 1 2 3 4 5 6 7 8 9 10 11 12 13 Family Name* Given Names* Preferred Name Date of Birth* format dd/mm/yyyy New Zealand Contact Address Tips

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Home Address Street / Road* Suburb* City / Town* Post Code Country* Country NEW ZEALAND AUSTRALIA ENGLAND ABU DHABI ALASKA ARGENTINA AUSTRIA BANGLADESH BELGIUM BERMUDA BOSNIA BRAZIL BRUNEI BULGARIA CAMBODIA CANADA CAYMAN ISLANDS CHINA CROATIA CYPRUS CZECH REPUBLIC DENMARK EGYPT ESTONIA ETHIOPIA FIJI FINLAND FRANCE FRENCH WEST INDIES GERMANY GREECE HOLLAND HUNGARY INDIA INDONESIA IRAN IRAQ IRELAND ISRAEL ITALY JAPAN KENYA KUWAIT LAOS LATVIA LEBANON LITHUANIA MACAU MALAYSIA MOROCCO NAMIBIA NAURU NETHERLANDS ANTILLES NIGERIA NORFOLK ISLAND NORWAY PAPUA NEW GUINEA PHILLIPINES POLAND ROMANIA RUSSIA SAMOA SAUDI ARABIA SCOTLAND SEYCHELLES SINGAPORE SOLOMON ISLANDS SOUTH AFRICA SOUTH KOREA SPAIN SRI LANKA SURABAYA SWEDEN SWITZERLAND TAIWAN THAILAND TONGA TRINADAD & TOBAGO UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES OF AMERICA VANUATU VIETNAM WALES YUGOSLAVIA ZAMBIA ZIMBABWE Phone (Home)* Mobile (Home) Email (Home) Home Country Contact Address Tips

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Home Address Street / Road* Suburb* City / Town* Post Code Country* Phone (Home)* Mobile (Home) Email (Home) Citizenship Details Tips

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Country of Birth* Country of Citizenship* Nationality* Passport Number * Country where passport issued*
First Language* Other Languages

Home-Stay Required Yes No Tips

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Medical History and/or Special Learning Requirements * Select Yes No Tips

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Please provide details of any known health, learning or social difficulties

Caregiver in New Zealand* Select Yes No Tips

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Relationship* Select Option Both Parents Mother Father Other Family Name* Given Names* Title* Title Dame Dr Lady Master Miss Mr Mrs Ms Rev Sir The R.H. The Rev Canon Home Address Street / Road* Suburb* City / Town* Post Code Country* Phone (Home)* Phone (Business) Mobile (Home) Mobile (Business) Email (Home) * Email (Business) Occupation* Select Other Account Executive Account Manager Accountant Administrator Agent Anaesthetist Arborist Architect Artist Associate Director Bank Manager Banker Barrister Beauty Therapist Builder Business Analyst Business Consultant Business Development Manager Business Manager Businessman/Businesswomen Chartered Accountant Chef Chief Executive Officer Chief Financial Officer Chief Information Officer Chief Operations Officer Chiropractor Cinematographer Civil Engineer Clinical Psychologist Commissioner Company Director Computer Consultant Computer Engineer Computer Software Developer Consultant Credit Analyst Dental Hygienist Dental Surgeon Dental Technician Dentist Designer Director Doctor Editor Engineer Executive Farmer Financial Advisor/Analyst Financial Consultant Financial Controller Financial Director/Manager Gastroenterologist General Manager General Practitioner Group Debt Manager Homemaker/Houseperson Human Resources Manager Insurance Broker Interior Designer Investment Analyst Investment Banker IT Client Executive IT Consultant IT Manager Jeweller Journalist Judge Landscape Designer Lawyer Lecturer Librarian Management Consultant Manager Managing Director Marketing Manager Member of Parliament Merchant Merchant Banker Minister Nurse Occupational Therapist Optometrist Orthopaedic Surgeon Osteopath Paediatrician Pastor Personal Assistant Pharmacist Photographer Physician Physiotherapist Pilot Planner Plastic Surgeon Policy Analyst Principal Producer Professor Project Manager Property Developer Property Investor Property Manager Psychiatrist Psychologist Publisher Quality Analyst Quantity Surveyor Radiographer Real Estate Agent Receptionist Registered Nurse Reporter Representative Retired School Librarian Scientist Secretary Security Officer Solicitor Strategy Manager Teacher Teacher Aid Technician Therapist Translator Travel Agent/Broker/Consultant Valuer Vicar Vice President Wholesaler Writer if Other* Occupation(Industry)* Select Other Accounting Administration Advertising/Media/Entertainment Banking & Financial Services Call Centre/Customer Servcies Community & Sport Construction Consulting & Corporate Strategy Education & Training Engineering Government/Defence Healthcare and Medical Hospitality & Tourism HR & Recruitment IT&T Insurance & Superannuation Legal Manufacturing/Operations Mining, Oil & Gas Primary Industry Real Estate & Property Retail & Consumer Products Sales & Marketing Science Technology Self-Employment Trades & Services Transport & Logistics Business Name Same as home Street / Road Suburb City / Town Post Code Country

Mother / Step Mother / Guardian Father / Step Father / Guardian Relationship* Relationship Guardian Mother Stepmother Relationship Father Guardian Stepfather Family Name* Given Names* Title* Title Dame Dr Lady Master Miss Mr Mrs Ms Rev Sir The R.H. The Rev Canon Title Title Dame Dr Lady Master Miss Mr Mrs Ms Rev Sir The R.H. The Rev Canon Home Address Same as spouse Street / Road* Suburb* City / Town* Post Code Country* Phone (Home)* Phone (Business) Mobile (Home) Mobile (Business) Email (Home)* Email (Business) Occupation* Select Other Account Executive Account Manager Accountant Administrator Agent Anaesthetist Arborist Architect Artist Associate Director Bank Manager Banker Barrister Beauty Therapist Builder Business Analyst Business Consultant Business Development Manager Business Manager Businessman/Businesswomen Chartered Accountant Chef Chief Executive Officer Chief Financial Officer Chief Information Officer Chief Operations Officer Chiropractor Cinematographer Civil Engineer Clinical Psychologist Commissioner Company Director Computer Consultant Computer Engineer Computer Software Developer Consultant Credit Analyst Dental Hygienist Dental Surgeon Dental Technician Dentist Designer Director Doctor Editor Engineer Executive Farmer Financial Advisor/Analyst Financial Consultant Financial Controller Financial Director/Manager Gastroenterologist General Manager General Practitioner Group Debt Manager Homemaker/Houseperson Human Resources Manager Insurance Broker Interior Designer Investment Analyst Investment Banker IT Client Executive IT Consultant IT Manager Jeweller Journalist Judge Landscape Designer Lawyer Lecturer Librarian Management Consultant Manager Managing Director Marketing Manager Member of Parliament Merchant Merchant Banker Minister Nurse Occupational Therapist Optometrist Orthopaedic Surgeon Osteopath Paediatrician Pastor Personal Assistant Pharmacist Photographer Physician Physiotherapist Pilot Planner Plastic Surgeon Policy Analyst Principal Producer Professor Project Manager Property Developer Property Investor Property Manager Psychiatrist Psychologist Publisher Quality Analyst Quantity Surveyor Radiographer Real Estate Agent Receptionist Registered Nurse Reporter Representative Retired School Librarian Scientist Secretary Security Officer Solicitor Strategy Manager Teacher Teacher Aid Technician Therapist Translator Travel Agent/Broker/Consultant Valuer Vicar Vice President Wholesaler Writer if Other* Occupation(Industry)* Select Other Accounting Administration Advertising/Media/Entertainment Banking & Financial Services Call Centre/Customer Servcies Community & Sport Construction Consulting & Corporate Strategy Education & Training Engineering Government/Defence Healthcare and Medical Hospitality & Tourism HR & Recruitment IT&T Insurance & Superannuation Legal Manufacturing/Operations Mining, Oil & Gas Primary Industry Real Estate & Property Retail & Consumer Products Sales & Marketing Science Technology Self-Employment Trades & Services Transport & Logistics Select Other Accounting Administration Advertising/Media/Entertainment Banking & Financial Services Call Centre/Customer Servcies Community & Sport Construction Consulting & Corporate Strategy Education & Training Engineering Government/Defence Healthcare and Medical Hospitality & Tourism HR & Recruitment IT&T Insurance & Superannuation Legal Manufacturing/Operations Mining, Oil & Gas Primary Industry Real Estate & Property Retail & Consumer Products Sales & Marketing Science Technology Self-Employment Trades & Services Transport & Logistics Business Name Address same as home Address same as home Street / Road Suburb City / Town Post Code Country* Secondary School Attended* Select School Other Auckland Normal Intermediate Balmoral School (Auckland) Bayfield School Bombay School Chilton St James School Churchill Park School Clevedon School Cockle Bay School Corran School Diocesan School For Girls Epsom Girls' Grammar School Epsom Normal School Ficino School Freemans Bay School Gladstone School (Auckland) Glendowie School Halsey Drive School Kamo Intermediate Kings College Kohia Terrace School Kohimarama School Kristin School Maungawhau School Meadowbank School Milford School (Auckland) Mt Eden Normal School Newmarket School Parnell School Pinehurst School Ponsonby Intermediate Ponsonby Primary School Pt Chevalier School Queen Margaret College Rangi Ruru Girls' School Remuera Intermediate Remuera School Royal Oak School St Cuthbert's College (Epsom) St Heliers School St Kentigern College (Pakuranga) St Kentigern Primary School (Remuera) St Michael's School (Remuera) St Paul's Collegiate (Hamilton) St Peter's School (Cambridge) St Thomas School (Auckland) Stanley Bay School Sunny Hills School Victoria Avenue School Westmere School (Auckland) If Other* Church attended Denomination* Select Religion Other Anglican Baptist Buddhist Catholic Greek Orthodox Hindu Islam Jew Lutheran Muslim Presbyterian Protestant Uniting Denomination* Select Religion Other Anglican Baptist Buddhist Catholic Greek Orthodox Hindu Islam Jew Lutheran Muslim Presbyterian Protestant Uniting

Who to contact if parents are separated or divorced Tips

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Not Applicable If applicable, select relationship Select Option Both Parents Mother Father Other Family Name* Given Name* Date of Birth Relationship* Relationship Aunt Brother Cousin Godfather Godmother Grandparent Great Aunt Great Uncle Guardian Homestay Second Cousin Sister Step Brother Step Father Step Mother Step Sister Uncle Relative Attends or has Attended Diocesan * Select Yes No Tips

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Family Name* Maiden Name Given Names* Relationship* Relationship Aunt Cousin Grandmother Great Aunt Great Grandmother Half Sister Second Cousin Stepmother Years Attended House Affiliation Select House Cochrane Cowie Edwards Mary Pulling Mitchelson Neligan Roberton Selwyn Family Names* Maiden Names Given Names* Relationship* Relationship Aunt Cousin Grandmother Great Aunt Great Grandmother Half Sister Second Cousin Stepmother Years Attended House Affiliation Select House Cochrane Cowie Edwards Mary Pulling Mitchelson Neligan Roberton Selwyn Family Name* Maiden Name Given Names* Relationship* Relationship Aunt Cousin Grandmother Great Aunt Great Grandmother Half Sister Second Cousin Stepmother Years Attended House Affiliation Select House Cochrane Cowie Edwards Mary Pulling Mitchelson Neligan Roberton Selwyn

FEES

Parents / Guardians completing this form are responsible for payment of fees. In addition it is possible to nominate further persons / organisations who will also be responsible for payment of fees. Click here for Fees and Regulations Notice.

Further Person(s) Responsible for payment of fees Yes No Tips

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Name of person or Organisation*
Street / Road* Suburb* City / Town* Post Code Country* Phone (Home)* Phone (Business) Mobile (Home) Mobile (Business) Email (Home) Email (Business) DECLARATION

I have read this application and the terms and conditions of enrolment (and the regulations relating to borders at Innes House) and as a condition of the acceptance of the above student, agree to abide by them. Please note that the completion of this application gives the school permission to collect information and make credit enquiries about all persons or organisations responsible for payment of fees, and to do the same in relation to the collection of overdue amounts. By completing this application form we authorise any third party to provide the school such information as it may require for the credit enquiries or for collection of overdues amounts and authorise the school to provide to any third party the details it may have concerning us for credit rating or credit enquiry purposes.

Agree
Disagree ATTACH THE FOLLOWING DOCUMENTS * Tips

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Recent passport size photograph Copy of passport Copy of Birth Certificate Copy of Parent's Passports Photocopies of school reports and certificates Reference from current school PRIVACY ACT 1993

The information in relation to enrolment procedures is retained by the School and will be used for the following purposes:
- To maintain contact with parents and caregivers
- To facilitate the operation and administration of the School
- To facilitate the education and general enhancement of the student
- To provide for the health, welfare and safety of the student

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