no
Step 1
Step 2
Step 3
navigation_horizontal_round
1
#00548f
in_fadeIn next_fadeInRight back_fadeInLeft
no
0
#0073aa
off
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 child-ethnic-origin 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* ParentsGuardiansFirstNames /350 placeholder “First Names *”]
[text* ParentsGuardiansSurname /350 placeholder “Surname *”]
[text* ParentsGuardiansAddress /350 placeholder “Address *”]
[text* ParentsGuardiansPostCode /100 placeholder “Postcode”]
[tel* ParentsGuardiansHomePhone /100 placeholder “Phone (Home) *”]
[tel ParentsGuardiansWorkPhone /100 placeholder “Phone (Work)”]
[tel* ParentsGuardiansMobilePhone /100 placeholder “Phone (Mobile) *”]
[email* ParentsGuardiansEmail /100 placeholder “Email *”]
[/repeater]
Emergency Contacts / Authority to Collect
[repeater repeater-166 max:5]
[text* ContactFirstNames /350 placeholder “First Names *”]
[text* ContactSurname /350 placeholder “Surname *”]
[text* ContactAddress /350 placeholder “Address *”]
[text* ContactPostCode /100 placeholder “Postcode”]
[tel* ContactHomePhone /100 placeholder “Phone (Home) *”]
[tel ContactWorkPhone /100 placeholder “Phone (Work)”]
[tel* ContactMobilePhone /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-Georges-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]
Signature *
[signature* signature-651]
[submit “Submit”][cf7mls_step cf7mls_step-3 “Back” “Step 3”]
1
[_site_title] “St Georges Preschool | Enrolment Agreement Form | [child-first-names] [child-surname]”
[_site_title] <[email protected]>
[email protected]
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: [child-ethnic-origin]
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]
—
This email was sent from St Georges Preschool | Enrolment Agreement Form on [_site_title]
[medical-immunisation-cert-file][custodial-statement-file]
1
[_site_title] “[your-subject]”
[_site_title] <[email protected]>
[your-email]
Message Body:
[your-message]
—
This email was sent from a contact form on [_site_title] ([_site_url])
Reply-To: [_site_admin_email]
Thank you for your message. It has been sent.
There was an error trying to send your message. Please try again later.
One or more fields have an error. Please check and try again.
There was an error trying to send your message. Please try again later.
You must accept the terms and conditions before sending your message.
Please fill out this field.
This field has a too long input.
This field has a too short input.
There was an unknown error uploading the file.
You are not allowed to upload files of this type.
The uploaded file is too large.
There was an error uploading the file.
Please enter a date in YYYY-MM-DD format.
This field has a too early date.
This field has a too late date.
Please enter a number.
This field has a too small number.
This field has a too large number.
The answer to the quiz is incorrect.
Please enter an email address.
Please enter a URL.
Please enter a telephone number.