Child Details. Child’s official given name: Child’s official surname or family name: Child’s official other names/middle name: Name your child is known by/preferred name: Surname/Family Name: Given Name: Copy of official identity verification document* collected by staff: ❑ New Zealand birth certificate ❑ Foreign birth certificate ❑ New Zealand passport ❑ Foreign passport ❑ Other Staff Initials: Child’s date of birth: dd / mm / yyyy Male ❑ Female ❑ Ethnic origin: Iwi your child belongs to: Language/s spoken at home: Child’s primary residential address: Parents / Guardians: Are parents living together ❑ or separated ❑? First Name(MOTHER): First Name(FATHER): Surname: Surname: Address:❑ (Same as Child) Address:❑ (Same as Child) Post Code: Post Code: Ph (Work): Ph (Home): Ph (work): Ph (home): Ph (Mobile): Ph (Mobile): Email: Occupation: Email: Occupation: Eg. Aunt ...................................................................................... Eg. Grandmother ......................................................................................
Child Details. Child’s official given name: Child’s official surname or family name: Child’s official other names/middle name: Please separate names with a comma Name your child is known by/preferred name: Surname/Family Name: Given Name: Copy of official identity verification document* collected by staff: ❑ New Zealand birth certificate ❑ Foreign birth certificate ❑ New Zealand passport ❑ Foreign passport ❑ Other Staff Initials: Child’s date of birth: dd / mm / yyyy Male ❑ Female ❑ Ethnic origin: Iwi your child belongs to: Language/s spoken at home: Child’s primary residential address: Parents / Guardians: Are parents living together ❑ or separated ❑? First Name(MOTHER): First Name(FATHER): Surname/Family Name: Surname/Family Name: Address:❑ (Same as Child) Address:❑ (Same as Child) Post Code: Post Code: Ph (Work): Ph (Home): Ph (work): Ph (home): Ph (Mobile): Ph (Mobile): Email: Occupation: Email: Occupation: Eg. Aunt ...................................................................................... Eg. Grandmother ......................................................................................
Child Details. Child’s Surname (as on birth certificate) Child’s Forename(s) (as on birth certificate) Name by which the child is known (if different from above) Child’s Date of Birth D D M M Y Y Gender Documentary proof of DoB Type (eg. Birthcertificate, Passport): Document recorded by (name of staff member): Date document recorded (dd/mm/yyyy) 30 hour eligibility code (if applicable): (eg.12345678912) 2 year funding eligibility (E) number (if applicable): Address Postcode White British Indian White Irish Pakistani Traveller of Irish Heritage Bangladeshi Gypsy/Roma Other Asian Other White Black Caribbean White and Black Caribbean Black African White and Asian Other Black White and Black African Other Mixed Chinese Other Ethnic Group Sudanese
Child Details. Xxxxx’s official given name: Xxxxx’s official surname or family name: Xxxxx’s official other names/middle name: Please separate names with a comma Name your child is known by/preferred name: Surname/Family Name: Given Name: Children may be enrolled into a service even if a parent/caregiver cannot provide identity documentation. It is important to ask for identity documentation, and if a parent/caregiver can provide it, please state in the enrolment form which documentation you sighted. Copy of official identity verification document* collected by staff: ❑ New Zealand birth certificate ❑ Foreign birth certificate ❑ New Zealand passport ❑ Foreign passport ❑ Other Staff Initials: Child’s date of birth: dd / mm / yyyy Male ❑ Female ❑ Ethnic origin: Iwi your child belongs to: Language/s spoken at home: Child’s primary residential address: Parents / Guardians: Given Names Are parents living together ❑ or separated ❑? First Name First Name Surname/Family Name: Surname/Family Name: ]Address:❑ (Same as Child) Address:❑ (Same as Child) Post Code: Post Code: Ph (Work): Ph (Home): Ph (work): Ph (home): Ph (Mobile): Ph (Mobile): Email: Occupation: Relationship to Child: Email: Occupation: Relationship to Child: Eg. Aunt ...................................................................................... Eg. Grandmother ......................................................................................
Child Details. Legal Forename in full (no nicknames or middle names) Address and post code Legal Surname Name by which child is known if different to above Gender Male / Female Date of birth Proof of identity (birth certificate, passport etc) Extended entitlement code 2+ Authorisation Code White British WBR White/Black Caribbean MWBC Indian AIND White Irish WIRI White/Black African MWBA Pakistani APKN Traveller of Irish Heritage XXXX Xxxxx and Asian MWAS Bangladeshi ABAN Gypsy/Roma WROM Any other mixed background MOTH Any other Asian background AOTH Any other White background WOTH Black Caribbean BCRB Chinese CHNE Refuse to provide REFU Black African BAFR Any other background OOTH Info not obtained NOBT Any other Black background BOTH
