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PLEASE PRINT THIS FORM, SIGN AND SCAN (OR PHOTOGRAPH) AND UPLOAD IT IN THE APPLICATION FORM
_SCHOOLNAME_ Declaration Form
We ask that all students and parents, or caregivers, read the enrolment contract carefully and ensure you have a good understanding. This includes the Accommodation Agreement if applicable. You must also ensure that all information given is accurate and complete. Please note that failure to disclose relevant information or the provision of false information may result in termination of enrolment.
STUDENT, PARENTS/LEGAL GUARDIANS DECLARATION AND AUTHORISATION
We declare that the information contained in this application is true and complete. We understand that any false or incomplete information submitted in support of this application may invalidate this application and may result in the withdrawal of an Offer of Place. We agree that we have received sufficient information to make an informed decision about enrolment at the School.
Key Terms: This Contract of Enrolment includes provisions:
- that allow the School to discipline the Student, including by expulsion
- that control and limit the Student's rights of refund when Enrolment ends early
- that require the Parents to make full disclosure of all relevant information
- that provide consent for the School to permit certain activities without further consent from the Parents.
This is an important legal document, please read all clauses carefully.
By signing this agreement you:
- Confirm that all of the information in the application form is true and complete.
- Confirm that where the Students is under 10 years of age, the Student will live with a parent or legal guardian in New Zealand while enrolled at a school unless they are accommodated in a school hostel.
_SCHOOLNAME_ Enrolment Contract Declaration
By signing below, you confirm that you have read the Enrolment Contract below (which includes our Terms and Conditions, Code of Conduct, Disciplinary Policy, and Refund Policy) and agree to be bound by it in all respects:
Name
Signature
Date
Parent/Caregiver:
Parent/Caregiver:
Student:
NZ School Signatory:
Homestay Declaration
By signing below, you confirm that you have read the Homestay Contract and agree to be bound by it in all respects
Name
Signature
Date
Parent/Caregiver:
Parent/Caregiver:
Student:
_SCHOOLNAME_ Designated Caregiver Contract Declaration
By signing below, you confirm that you have read the Designated Caregiver Contract and agree to be bound by it in all respects
Name
Signature
Date
Parent/Caregiver:
Parent/Caregiver:
Student:
Designated Caregiver:
Bethlehem College
International Student Application Form
Your progress so far
Click any step to see its details
Information Required
Note: It is important that you include all relevant information about the student in your application. This information is used to ensure that the student is supported properly upon arrival and to match them with suitable homestays, teachers and courses. Where information is included relating to health issues or learning needs, disclosure of this information will not automatically disqualify the Student from Enrolment. However, failure to disclose information or providing misleading information may result in the withdrawal of an Offer of Place or termination of a Contract of Enrolment.
Please make sure you have scanned copies of the following documents ready to upload before you begin:
- your current passport (if available)
- your photo
- your last school report (translated into English)
- vaccination certificate (if available)
- insurance certificate (if available and must be in English)
Please note: Fields marked with
★
are required and must be completed✽
Your information is saved every time you press the ‘Next Section’ button. Need a break? You can come back at any time at the link below.
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Student Details
First name (Name must be as it appears on your passport)
★
Middle names (must be as it appears on your passport)
Last name (must be as it appears on your passport)
★
Preferred first name
Date of birth
★
Please note: The Education (Pastoral Care of Tertiary and International Learners) Code of Practice 2021 requires that all students under the age of 10 must live with a parent for the duration of their enrolment at school in New Zealand.
Country of citizenship
★
Gender
★
Ethnicity
★
First language
★
Address (In home country)
★
★
★
★
Phone number (In home country)
+--
New Zealand mobile number
Email address
★
Social media address
Social media type
How long have you studied English?
Years
Months
What is your level of English?
Sporting Interests
Cultural Interests
Agency Information
(if using an agent)
Agency name
Agent name
Agent email address
Previous Applications
What is the name of the school you currently attend?
Have you applied to _SCHOOLNAME_ before?
When did you apply?
Have you studied in New Zealand before?
Which school did you study at?
Has a family member or relative ever enrolled at _SCHOOLNAME_ before?
Full name
Year attended
Travel Details
Arrival date (if available)
Passport number (if available)
Passport expiry
National ID Number (Chinese students Only)
★
Student Visa number (if available)
Student Visa issued
Student Visa expiry
Parents or Legal Guardian Details
Please note: it is a requirement of New Zealand regulations that schools must maintain effective communication with parents and legal guardians. To comply with the requirements, contact information provided in this section MUST be the contact information for the parents or legal guardian.
Parent One or Legal Guardian Details:
First Name
★
Middle Names
Last Name
★
Relationship (eg mother, father, aunt, guardian)
★
Occupation
Current Address
★
★
★
Work number
+--
Mobile number
+--
Email address
★
Passport number
Parent Two or Legal Guardian Details:
First name
Middle names
Last name
Relationship
Occupation
Current address
Work number
+--
Mobile number
+--
Email address
Passport number
Accommodation Requirements
What accommodation do you require?
★
Homestay Information
Letter to Homestay
Please write a short letter (below) to introduce yourself to your new host family. Tell them about your family, what you like, why you're coming to New Zealand any anything else you want them to know.
★
Important Homestay Considerations
Please include any important homestay requirements eg special dietary requirements, food allergies, pet allergies, religious requirements, phobias, etc. This information is important and is used to help us choose the best homestay for you.
★
Designated Caregiver (DCG) Details
(if you are staying with a relative or close family friend)
First name of caregiver
★
Middle names of caregiver
Last name of caregiver
★
Relationship to student (eg aunt, guardian, close family friend)
★
Occupation
New Zealand physical address
★
Work number
Mobile number
Email address
Please note: A DCG must be a relative or close family friend of the family. This accommodation must be approved by _SCHOOLNAME_ prior to the student's arrival. Please provide a copy of the passport (and visa if applicable).
Medical and Insurance Information
Do you wish to purchase insurance through the school?
★
An appropriate insurance policy is required and must cover travel and health to and from New Zealand and for the entire length of stay in New Zealand. Note: This Policy must be provided in English.
Insurance company
★
Insurance policy number
★
Insurance policy expiry
★
Please add your COVID-19 Vaccination Information (if available)
COVID-19 Vaccine Manufacturer
Date of First COVID-19 Vaccine Shot
Date of Second COVID-19 Vaccine Shot
Has the student been vaccinated for any diseases? (If 'Yes', upload an English copy of your vaccination certificate below)
★
Permission is given for _SCHOOLNAME_ to administer Paracetamol.
★
Permission is given for _SCHOOLNAME_ to administer Ibuprofen.
★
Medical Conditions
ADD/ADHD
Asthma
Back/Neck problems
Glandular Fever
Migraines
Diabetes
Hepatitis A, B or C
Depression/Anxiety
Heart Condition
Mobility Issues
Tuberculosis
Food Allergies
Eating Difficulties or Disorders
Epilepsy or Seizure Disorder
Bee/Wasp Sting Allergy
Metal Implants
Any Mental Illness
HIV or AIDS
Chronic Nose Bleeds
Dizzy Spells
Travel Sickness
Autism Spectrum Disorder
COVID-19
Additional medical information
Does the student have any pre-existing medical conditions (for insurance purposes) or history of previous illness that may affect the enrolment, including mental illness? If 'Yes', please provide details. Withholding information may result in your contract being terminated.
Current Medications
If the student suffers from conditions requiring medication, it is advisable to bring their own medication to New Zealand. You will be required to notify the school regarding any medications that you bring with you. The school WILL dispense any over the counter medications as it sees fit to students UNLESS specified below.
Allergies
Doctor name (in home country)
Doctor phone
+--
Emergency Contact
In your home country, other than your parents
First name
Last name
Relationship to the student
Phone number
+--
Address
Email address
Course Details
Study Programme
When will you start?
★
Term
★
Duration
★
Terms
| Start: |
★
|
| Finish: |
★
|
INFORMATION REGARDING SUBJECT SELECTION:
Year 9: select 4 option subjects, with at least 1 from each group.
Year 10: select 4 option subjects, with at least 1 from each group.
Year 11: select up to 3 option subjects.
Year 12: select up to 5 option subjects.
Year 13: select up to 6 subjects.
Please note: Course choices will be reviewed after enrolment and may be subject to change and availability.
Year 9: select 4 option subjects, with at least 1 from each group.
Year 10: select 4 option subjects, with at least 1 from each group.
Year 11: select up to 3 option subjects.
Year 12: select up to 5 option subjects.
Year 13: select up to 6 subjects.
Please note: Course choices will be reviewed after enrolment and may be subject to change and availability.
Year/Subjects
Learning and/or behavioural difficulties
Comments
Is there anything further that the school needs to be aware of in enrolling the student as an international student? If 'Yes', please provide details.
Declarations
All Contract Documents for _SCHOOLNAME_ must be fully read and understood and the Declaration Form signed as confirmation of this - to access these Contract Documents and the Declaration Form, click on the link below.
COMPULSORY: You MUST download, complete, and scan the form containing the declarations below
- Bethlehem College Enrolment Declaration
- Bethlehem College Hostel Declaration
- Bethlehem College Homestay Declaration
- Designated Caregiver Declaration
Please print, sign, scan (or photograph) and upload the Declaration in the 'File Uploads' section below under Signed Declaration.
File Uploads
Passport
Your Photo
Last School Report (translated into English)
Other file
Vaccination Certificate
Insurance Certificate (if available and must be in English)
Signed Declaration (see above)
Copy of COVID-19 Vaccine Certificate
Robot Check
Select the button with the correct answer to the following question:
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Application Submitted
Thank you! Your application has been successfully submitted. We will be in contact with you shortly.