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Step 2
Step 3
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Child
[text* child-first-names /350 placeholder “Child’s first names *”]
[text* child-surname /350 placeholder “Surname *”]
[text* child-preferred-name /350 placeholder “Preferred name *”]
[text* child-date-of-birth /150 placeholder “Child’s date of birth *”]
[radio child-gender use_label_element default:1 “Male” “Female”]
[text* child-home-address /350 placeholder “Child’s home address *”]
[text* child-post-code /100 placeholder “Postcode *”]
Ethnic origin
[checkbox checkbox-989 label_first use_label_element exclusive “Maori” “Tokelaun” “Fijian” “Chinese (incl. Taiwanese)” “Niuean” “Tongan” “Cook Is Maori” “Other Asian” “Samoan” “Other Pacific Peoples” “South East Asian” “Middle Eastern, Latin American, African” “Indian” “NZ European” “Other European” “Other (ethnicity not stated)”]
[text child-iwi-belongs-to /250 placeholder “Iwi your child belongs to”]
Is there anything else we should know about your child’s ethnicity, religion or culture so we can ensure the best cared and understanding?
[textarea child-anything-else x2 350]
Child Medical Information
[text medical-doctor-name /350 placeholder “Doctors Name”]
[text medical-address /350 placeholder “Address”]
[tel medical-phone /150 placeholder “Phone”]
[text medical-facility /250 placeholder “Medical Facility”]
[textarea medical-conditions x3 /350 placeholder “Allergy or medical conditions”]
Immunisation certificate supplied? *
[checkbox* medical-immunisation-cert use_label_element exclusive “No” “Yes”]
[group group-238 clear_on_hide]
Please upload certificate
[file medical-immunisation-cert-file]
[/group]
[cf7mls_step cf7mls_step-1 “Next” “Step 1”]
Parents/Guardians
[repeater repeater-930 max:5]
[text* pg-first-names /350 placeholder “First Names *”]
[text* pg-surname /350 placeholder “Surname *”]
[text* pg-address /350 placeholder “Address *”]
[text* pg-post-code /100 placeholder “Postcode”]
[tel* pg-home-phone /100 placeholder “Phone (Home) *”]
[tel pg-work-phone /100 placeholder “Phone (Work)”]
[tel* pg-mobile-phone /100 placeholder “Phone (Mobile) *”]
[email* pg-email /100 placeholder “Email *”]
[/repeater]
Emergency Contacts / Authority to Collect
[repeater repeater-166 max:5]
[text* emergency-contact-first-names /350 placeholder “First Names *”]
[text* emergency-contact-surname /350 placeholder “Surname *”]
[text* emergency-contact-address /350 placeholder “Address *”]
[text* emergency-contact-post-code /100 placeholder “Postcode”]
[tel* emergency-contact-home-phone /100 placeholder “Phone (Home) *”]
[tel emergency-contact-work-phone /100 placeholder “Phone (Work)”]
[tel* emergency-contact-mobile-phone /100 placeholder “Phone (Mobile) *”]
[/repeater]
Custodial Statement
Are there any custodial arrangements concerning your child?
[checkbox* custodial-statement use_label_element exclusive “No” “Yes”]
[group group-237 clear_on_hide]
[file custodial-statement-file]
[/group]
[cf7mls_step cf7mls_step-2 “Back” “Next” “Step 2”]
Enrolment Terms and Conditions
Enrolment-Terms-and-Conditions-St-Marys-Preschool[acceptance acceptance-367] I undertake to adhere to the requirements of these terms and conditions and I also take responsibility for the payment of fees on time. I undertake that failure to comply with these requirements of the Preschool could lead to my child’s exclusion from the Preschool. [/acceptance]
[submit “Submit”][cf7mls_step cf7mls_step-3 “Back” “Step 3”]
1
[_site_title] “St Marys Preschool | Enrolment Agreement Form”
[_site_title]
[_site_admin_email]
Child
Child’s first names: [child-first-names]
Surname: [child-surname]
Preferred name: [child-preferred-name]
Child’s date of birth: [child-date-of-birth]
Gender: [child-gender]
Child’s home address: [child-home-address]
Postcode: [child-post-code]
Ethnic origin: [checkbox-989]
Iwi your child belongs to: [child-iwi-belongs-to]
Is there anything else we should know about your child’s ethnicity, religion or culture so we can ensure the best cared and understanding?
[child-anything-else]
Child Medical Information
Doctors Name: [medical-doctor-name]
Address: [medical-address]
Phone: [medical-phone]
Medical Facility: [medical-facility]
Allergy or medical conditions: [medical-conditions]
Immunisation certificate supplied? [medical-immunisation-cert]
[medical-immunisation-cert-file]
Parents/Guardians
[repeater-930]
Emergency Contacts / Authority to Collect
[repeater-166]
Custodial Statement
Are there any custodial arrangements concerning your child? [custodial-statement]
[custodial-statement-file]
Enrolment Terms and Conditions
I undertake to adhere to the requirements of these terms and conditions and I also take responsibility for the payment of fees on time. I undertake that failure to comply with these requirements of the Preschool could lead to my child’s exclusion from the Preschool.
—
This email was sent from St Marys Preschool | Enrolment Agreement Form on [_site_title]
[medical-immunisation-cert-file][custodial-statement-file]
[_site_title] “[your-subject]”
[_site_title]
[your-email]
Message Body:
[your-message]
—
This email was sent from a contact form on [_site_title] ([_site_url])
Reply-To: [_site_admin_email]
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