INTERNATIONAL STUDENT ENROLMENT FORM (Designated Caregiver Version)

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1 INTERNATIONAL STUDENT ENROLMENT FORM (Designated Caregiver Version) Avondale College International Department Telephone: intl@avcol.school.nz Website:

2 ACADEMIC COURSE ENTRY LEVEL: START DATE: LENGTH OF STUDY: Year 9 Year 10 Year 11 Year 12 Year years old years old years old years old years old Term One Term Two Term Three Term Four Year 20 Start January Start April Start July Start October 1 Term 2 Terms (Half Year) 3 Terms 4 Terms (Full Year) STUDENT First Name: Middle Name: Surname: Preferred Name (Nickname): Date of Birth: Gender: Address Line 1: Address Line 2: Address Line 3: Town/City: Postcode: Country: Overseas Phone: Address: Ethnic Group/s: Country of Citizenship: (as on passport) (as on passport) Female Male First Language: Passport Number: Passport Expiry: STUDENTS PARENTS Mothers First Name: Fathers First Name: Mothers Surname: Fathers Surname: Address: Address: Mothers Occupation: Fathers Occupation: Mothers Home Phone: Fathers Home Phone: Mothers Mobile Number: Fathers Mobile Number: Mothers Work Phone: Fathers Work Phone: Mothers Fathers PAGE 1

3 STUDENTS AGENT (IF APPLICABLE) Company: Agents Name: Phone Number: Mobile Number: Emergency Number: Address: Address Line 1: Address Line 2: Address Line 3: Town/City: Postcode: Country: GENERAL DETAILS Have you studied at a NZ School before? Yes No If Yes, when?: School Previously Attended in NZ: Present School Attending: Do you intend to sit NCEA exams? Yes No Please include copies of any NCEA results already obtained What is your planned future career? SUBJECT CHOICES Please list your subject choices below. To ensure you have a better chance of gaining entry into your subject requests, please select and record below when completing this application. English language standards are required for entry into the Academic course. Some options require placement tests. Year 9 Year 10 Year 11 Year 12 Year 13 All students study English, Mathematics, Science, Social Science, Technology and Health & Physical Education. They can choose two art options and one language option. All students study English, Mathematics, Science, Social Science and Health and Physical Education. They can choose three options. A language is recommended, but is not compulsory. All students study five subjects including English and Mathematics. They can choose three options. Science is highly recommended. All students study five subjects including English. They can choose four options. All students study five subjects. English is highly recommended. Subject Year Level 9, 10, 11, 12,13 1. English / ESOL Please note: You might not get your preferred options as some classes may fill up very fast. Entry to some subjects is subject to availability and students starting in Terms 2, 3 and 4 may have limited subject choices due to courses being full. PAGE 2

4 DESIGNATED CAREGIVER DETAILS Street Address: Suburb: Home Phone Number: Address: Caregiver 1 Details: Name: Date of Birth: Occupation: Nationality: Mobile Phone Number: Work Phone Number: Caregiver 2 Details (if applicable): Name: Date of Birth: Occupation: Nationality: Mobile Phone Number: Work Phone Number: Relationship to student (e.g. Aunt, Uncle): Please note: A Designated Care Giver must be a relative or close friend of your family. This accommodation must be approved by Avondale College prior to the students arrival. Please provide a copy of the care givers passport (and visa if applicable). Are there any other occupants in the house: Family Members Names: (Living at the address) Yes No Please complete the below table if there are other occupants in the house Date of Birth: Relationship to you: (e.g. son, daughter, friend) School/Occupation: In order to comply with Avondale College s accommodation requirements the student must have their own room inside the house containing a bed, cupboard, drawers, desk, chair, mirror and adequate heating and lighting. In complying with the Code of Practice, all caregivers are required to complete the police vetting procedures. Each occupant residing at the address that is 18 years or older must complete a police vetting form. PAGE 3

5 HEALTH RECORD CURRENT HEALTH CONCERNS / MEDICAL HISTORY Are you currently, or have you previously suffered from any medical conditions? e.g. Asthma, Head Injury, Depression, Diabetes, Eating Disorder, Epilepsy, Hearing/Vision Impairment, Hepatitis A, B or C, HIV or Aids, Heart Condition, Migraines Are you currently taking any medications? Do you have any allergies to food, medications, stings etc? Please list the allergy and describe the reaction, the severity of the reaction, and the required treatment. Do you have any special learning needs? e.g. ADHD, ADD, Dyslexia. Please Note: If you suffer from any of the above conditions, it is advisable to bring your own medication to NZ. As part of signing this application you are giving permission, in the case of an emergency, for this information to be passed on to a doctor or hospital, for the school to seek medical advice and also indicating your acceptance of the responsibility to reimburse the school for reasonable costs incurred. In the event that Avondale College is unable to contact you, the parents agree that Avondale College will act on your behalf to seek appropriate medical treatment. EMERGENCY CONTACT DETAILS If we are unable to get hold of students parents, who should we contact in the event of an emergency? Emergency Contact 1: Contacts Mobile Number: Emergency Contact 2: Contacts Mobile Number: PAGE 4

6 HEALTH INSURANCE Eligibility for Health Services Most international students are not entitled to publicly funded health services while in New Zealand. If you receive medical treatment during your visit, you may be liable for the full costs of that treatment. Full details on entitlements to publicly-funded health services are available through the Ministry of Health, and can be viewed on their website at The Accident Compensation Corporation provides accident insurance for all New Zealand citizens, residents and temporary visitors to New Zealand, but you may still be liable for all other medical and related costs. Further information can be viewed on the ACC website at It is a requirement of Immigration New Zealand that International students must have appropriate and current medical and travel insurance while studying in New Zealand. Evidence of this must be produced when the full fee is paid. Your insurance policy must be in English and compliant with Immigration New Zealand s requirements and be approved by Avondale College. Avondale College can arrange insurance on your behalf with Southern Cross or Unicare. The cost of this will be included in your invoice. HEALTH/TRAVEL INSURANCE (This is mandatory for all International Students) Do you require Avondale College to provide health/travel/personal liability insurance? No Yes - Southern Cross Yes - Unicare PRE-EXISTING CONDITIONS Pre-existing conditions are not automatically covered under international student policy. If you have any pre-existing conditions that you would like to seek cover for, please declare these now. Pre-existing conditions that you do not want to seek cover for, or do not tell us about, will remain excluded under your policy What is a pre-existing condition? For the purposes of the international student policy, a pre-existing condition is: in relation to each person named on your certificate of insurance, any medical or physical conditions (including congenital conditions, anomalies or defects but excluding congenital blindness and deafness) symptoms or circumstances which you are aware of, or a reasonable person in your circumstances out to have been aware of: a) for which advice, care, treatment, medication or medical attention has been sought, given or recommended, or b) for which you are awaiting test results or further investigation, specialist treatment or specialist consultation; or c) which have been diagnosed as a medical condition, or indicative of a medical condition; or d) which are of such a nature to require, or which potentially may require medical attention; or e) which are of such a nature as would have caused a prudent, reasonable person to seek medical attention; Prior to your start date of insurance and regardless of whether or not a medical diagnosis has been made. I have read and understood What is a pre-existing condition? above Please carefully select an option below: I do not have any pre-existing conditions. (Select this option if you do not have any pre-existing conditions) I wish to apply for cover for my pre-existing conditions. (Select this option if you have any pre-existing conditions that you would like to apply for cover for. A medical assessment will be completed and we will be advised whether cover can be offered for the pre-existing conditions). I have a pre-existing conditions but do not want to apply for cover for it. (Select this option if you do NOT want to apply for cover for your pre-existing conditions, & accept that they will not be covered under this policy). PAGE 5

7 INTERNATIONAL STUDENT REFUND POLICY Avondale College Board of Trustees guarantees to have sufficient funds in reserve to enable refunds of unused portion of fees, should Avondale College be unable to proceed with a course for the student applicants. This policy is based on Section 4[B]7 of the Education Amendment [No 4] Act B[7] Where at any time a foreign student withdraws from a subject, course or programme at a state school, the Board may refund to the person who paid (in respect of the students enrolment in the subject, course or programme) the amount of fees referred in subsection (1) of this section (or sum of any installments paid in respect of those fees) any amount it thinks appropriate not exceeding the extent (if any) by which the amount paid exceeds the sum of the following amounts. a) The Boards best estimate of the cost to the Board (including the appropriate proportion of the Boards administrative and other general costs and the appropriate proportion of any initial or start-up costs of the subject, course, or programme for one student up to that time); b) An amount that is in the Boards opinion an appropriate reflection of the use made by one student receiving tuition in the subject, course or programme of the Boards capital facilities; c) The appropriate proportion of the amount (if any) prescribed under section 4D of this Act for a student receiving tuition at a state school in the subject, course or programme; d) All other fees (if any) prescribed by the Board; In order to be eligible for any refund the parent must apply in writing to the Board of Trustees, setting out the special circumstances of the claim. In arriving at their decision the Board of Trustees will take into consideration the special circumstances of the withdrawing student and: a) Costs already incurred by the Board b) The salaries of the teachers and associate staff and any other components of the fee already committed for the duration of the course c) An amount which covers the use of the facilities and resources to date of withdrawal d) Any refund of the foreign students fee, from the government Except in exceptional circumstances, no refund is payable where a student withdraws in the second half of the course. In the case a full year Student, the second half of the course commences on the first day of the term after two terms have been completed. Explanation Where a parent withdraws from the contract before the student arrives in New Zealand, fees paid are refunded at the discretion of Avondale College. In these cases under New Zealand the College must retain amounts to cover costs already incurred. The balance may be returned. Parents whose students are insured with Unicare may have the balance of their fees reimbursed by that company. NO refunds will be made to parents where students: 1. Are asked to leave the College because of misbehavior, poor attendance or violation of the rules regarding motor vehicles; 2. Wish to transfer to another school for Whatever reason; 3. Acquire Permanent Residence after having enrolled at Avondale College (or parents acquire a work/business visa) Refund Conditions To be eligible for a refund an application must be made in writing to the Board of Trustees by the parent or legal guardian clearly stating the reason for withdrawal of the student. In determining any refund, the Board of Trustees will take into consideration the special circumstances of the withdrawing student and: - The costs to the school in providing tuition - Costs incurred in employing staff and providing facilities - Payments made to the New Zealand Government No refund will be made to any student who is asked to leave because of misbehavior, poor attendance or violation of the contract with the school. PAGE 6

8 ENROLMENT AGREEMENT THE TERMS AND CONDITIONS APPENDED TO THIS APPLICATION, FORM AND GOVERN THE STUDENT S TUITION AT THE SCHOOL. BY SIGNING BELOW, THE STUDENT, THE SCHOOL AND THE PARENTS OR LEGAL GUARDIAN AGREE TO THOSE TERMS AND CONDITIONS. PLEASE ENSURE THE TERMS AND CONDITIONS ARE READ CAREFULLY. Terms and Conditions: 1. For the purposes of this Agreement the following terms shall have the following meanings: Agreement or Designated Caregiver Agreement being entered into by all relevant parties. Accommodation means the residential accommodation provided to the Student pursuant to the Accommodation Agreement. 6. The Fee must be paid to the School in advance of each Period of Study or as otherwise directed by the School. The Parents or Legal Guardians and the Student agree to comply with school policies regarding the payment of the Fee. Accommodation Agreement means the agreement between the Student, the School, the Parents or Legal Guardians, which governs the Student s accommodation arrangements. 7. If Tuition is terminated by the School during a Period of Study, in accordance with the Act and the Code, any refund of the Fee applicable to that Period of Study will be assessed in accordance with school policies. Act means the Education Act Agreement means this Agreement including any schedules. Application Form means the standard enrolment form which forms the cover page of Agreement. 8. The Parents or Legal Guardians and the Student, who have signed this Agreement irrevocably appoint and authorise the principal of the School (or such other person as may be appointed by the School to carry out the principal s duties) to: Code means the Education (Pastoral Care of International Students) Code of Practice Fee means fees payable by the Parents or Legal Guardians to the School as per the Fee Schedule. Fee Schedule means the schedule of Accommodation and miscellaneous charges. fees for (a) Receive information from any person, authority, or corporate body concerning the Student including, but not limited to, medical, educational or welfare information; Tuition, Homestay has the meaning as set out in the Code. (b) Provide consents that may be necessary to be given on the Student's behalf in the event of a medical emergency where it is not reasonably practicable to contact the Parents or Legal Guardians. Parents or Legal Guardians means the parents or legal guardians referred to in the annexed Application Form. Residential Caregiver has the meaning as set out in the Code. School means the school referred to in the annexed Application Form. 9. The Parents or Legal Guardians irrevocably authorise the principal of the School to advise the Residential Caregiver (whether or not arranged through the school) of all matters and information required to be provided to the Parents or Legal Guardians and agree to appoint the Residential Caregiver in New Zealand to receive such information in substitution for the Parents or Legal Guardians. Student means the school referred to in the annexed Application Form. Tuition means the education of the Student at the School. Period of Study means any period for which Fees are paid and for the purpose of this Agreement the enrolment of the Student begins on the course start date stated in the Student s offer of place and ends on the course end date stated in the Student s offer of place. 10. The Parents or Legal Guardians agree to provide the School with academic, medical or other information relating to the wellbeing of the Student as may be requested from time to time by the School. If the Parents or Legal Guardians provide misleading information or fail to disclose information about the Student to the School, such that the School has to change or modify the level of Tuition or Accommodation required by the Student, the School may charge the Parent or Legal Guardians such fees as required to adequately compensate for such additional requirements. 2. The School shall provide Tuition to the Student in accordance with school policies, the Code, the Act and any other applicable laws, in return for the payment of the Fee. 3. The Parents or Legal Guardians and Student agree that no changes to accommodation arrangements will be made whatsoever without the prior written agreement of the School. 4. The Parents or Legal Guardians and Student agree to comply with the immigration requirements as set out in the Immigration Act 2009, and any immigration conditions applicable to the Student s stay in New Zealand. The Parents or Legal Guardians and Student understand that the School has an obligation to report any breaches of the immigration requirements to the appropriate immigration authority. 11. The Parents or Legal Guardians agree that it is a condition of enrolment that the Student has current and comprehensive travel and medical insurance. If requested, the Parents or Legal Guardians will provide the School with evidence of the relevant insurance policy. 5. The Parents or Legal Guardians and the Student agree that this Agreement is subject to an Accommodation 13. Nothing in this Agreement limits any rights that the Parents, Legal Guardians or Student may have under the Consumer Guarantees Act The School shall at all times comply with the Health and Safety at Work Act PAGE 7

9 ENROLMENT AGREEMENT complies with the Code. If this condition is unable to remain fulfilled, than this agreement will be at an end. 14. It is acknowledged that provisions in the Act relating to the suspension, expulsion or exclusion of students will apply to the Student while in New Zealand. Any decision to expel or exclude the Student shall terminate this Agreement and the School s refund policy will apply. (d) Personal information of the Student and/or Parents or Legal Guardians collected or held by the School is provided and may be held, used and disclosed to enable the School to process the Student s eligibility to receive Tuition at the School and Accommodation. 15. The Student will comply at all times with school policies, the Code and the Act, and the Parents or Legal Guardians shall work with the School to ensure such compliance. (e) All personal information provided to the School is collected and will be held by the School. 16. No party to this Agreement is liable to the other for failing to meet its obligations under this Agreement to the extent that the failure was caused by an act of God or other circumstances beyond its reasonable control. (f) The Student and Parents or Legal Guardians have the right under the Privacy Act 1993 to obtain access to and request corrections of any personal information held by the School concerning them. 17. This Agreement shall be construed and take effect in accordance with the non-exclusive laws of New Zealand. In relation to any legal action or proceedings arising out of or in connection with this Agreement the Parents or Legal Guardians irrevocably: (g) Under the Privacy Act 1993, any information collected may be provided to education authorities. (h) Information relating to the education, health, welfare or safety of the Student, may be released to relevant parties outside the School, at the discretion of the School. (a) Submit to the non-exclusive jurisdiction of the Courts of New Zealand; and (b) Agree that proceedings may be brought before any Court including any forum constituted under the Arbitration Act 1908 within New Zealand, and waive any objection to proceedings in any such Court or forum on the grounds of venue or on the grounds that the proceedings have been brought in an inconvenient forum. 21. Photographs and videos of the Student may be used for the Student s records and in any publicity material for the School. 22. The School's responsibility for the Student ends on the last day of the Period of Study, or in the event that the Student s Tuition is terminated, on the date of termination. 18. Notices given under this Agreement must be in writing and given to the addresses set out in the Application Form. Those notices sent by post will be deemed to have been received ten (10) days after posting. The Parties also agree that correspondence is a suitable means of communication and s will be deemed to have been received when acknowledged by the party or by return The conditions in this Agreement apply for the whole time the Student is enrolled at the School during a Period of Study. The Agreement may be renewed on application to the School in writing. Renewal of this Agreement is at the sole and absolute discretion of the School and is subject to satisfactory performance and attendance by the Student, the issue of an offer of place for a further Period of Study and the payment of Fees. 19. This Agreement contains the entire understanding of the parties and overrides any prior promises, representations, understandings or agreements. The terms of the Agreement may be changed by the School in consultation with the Student, and Parents or Legal Guardians, except where such change is required by New Zealand legislation or the Code. This Agreement shall continue in force during the Year of Study with the School. 24. Without limiting any obligations set out in school policies, the Parents or Legal Guardians and Student agree that the Student: (a) Must comply with school policies; (b) Must comply with all terms of the accommodation Agreement; and 20. The Parents or Legal Guardians and Student acknowledge that: (c) Must maintain an up-to-date visa as stipulated by Immigration New Zealand. (a) The School may obtain at any time from any person or entity any information it requires to process and/or accept the Student for admission to the School or to perform or complete any of the other purposes under this Agreement. The Parents or Legal Guardians and the Student authorise any such person to release to the School any personal information that person holds concerning the Student and/or Parents or Legal Guardians. 25. The parties acknowledge that prior to signing this Agreement, they have had the opportunity to seek independent legal advice in respect of its content and effect. 26. This Agreement may be executed in one or more counterparts, each of which when so executed and all of which together shall constitute one and the same Agreement. Delivery of executed counterparts may be delivered by or facsimile transmission. (b) If the Student and/or Parents or Legal Guardians fail to provide any information requested in relation the Students admission to the School, the School may be unable to process the Student s application. 27. The parties agree that any dispute in relation to this Agreement will be resolved in accordance with the Code and the School Policies. (c) This Agreement is conditional at all times on the Student having accommodation in New Zealand which PAGE 8

10 ENROLMENT AGREEMENT PARENTS/LEGAL GUARDIANS AND STUDENTS 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 enrolment. We agree that we have received sufficient information to make an informed decision about enrolment at the School. EXECUTION Parents/Legal Guardians By signing below, the Parents or Legal Guardians (as applicable) confirm that they have read the Agreement and agree to be bound by it in all respects: Mothers Name: Fathers Name: Mothers Signature: Fathers Signature: Student By signing below, the Student confirms he/she has read and understood the Agreement and agrees to abide by the Code, School Policies and (to the extent applicable) the Agreement: Student Name: Student Signature: School By signing below, the authorised signatory of the School confirms that they are authorised to sign on behalf of the School, and confirms that the School will be bound by the Agreement in all respects: School Representative: Signature: PAGE 9

11 DESIGNATED CAREGIVER AGREEMENT This is an agreement between the Parent/s, the Designated Caregiver and the School (the Agreement). School Name: Avondale College (the School) Student s Name: (the Student) Mother s Name: Father s Name: (together the Parents, each a Parent) Name of relative or close family friend: (the Designated Caregiver) Address: (the Residence) AGREEMENTS 1. The Parents agree that the Designated Caregiver will provide residential care for the Student while enrolled as an international student at the School. 2. The School has provided, and the Designated Caregiver has read and understood, the sections of the Education (Pastoral Care of International Students) Code of Practice 2016 (the Code) relevant to residential caregivers and the Information for Residential Caregivers booklet and agrees to act as Designated Caregiver to the Student in accordance with these requirements. 3. The School agrees that all information regarding the Designated Caregiver relating to the Agreement will be kept confidential, except disclosure to the Student or their parents or their legal guardians, to any professional consultant or such person where it is in the interests of the Student to provide the information or pursuant to any statutory or other legal duty. 4. Approval is required from the School prior to the Student s placement with the Designated Caregiver. 5. The Designated Caregiver agrees that approval will be provided only after appropriate safety and other checks have been completed by the School in accordance with the Code and school policies. 6. Failure by the Designated Caregiver to provide the residential care required by the School and the Code may result in the school s approval of the Designated Caregiver being withdrawn. 7. In the event the school withdraws its approval of the Designated Caregiver, the Agreement is terminated and the Student will be placed in alternative accommodation approved by the School at the full cost and expense of the Parent/s. 8. The School may take such measures as it considers appropriate (acting reasonably) to monitor and review the quality of residential care by the Designated Caregiver and this may include, without limitation, regular visits to the Designated Caregiver and meetings with both the Student and the Designated Caregiver. 9. The Designated Caregiver will provide the School with no less than fourteen days (14) days prior notice of any change in circumstances that may affect the Agreement. This includes any change of Residence or any change to the number of adults over eighteen (18) years of age living at the Residence. 10. The Parent/s agree that the School is not responsible for the Student s care while in the custody of the Designated Caregiver. 11. The parties agree that any dispute in relation to this Agreement will be resolved in accordance with the Code and the school policies. 12. This Agreement may be executed in one or more counterparts, each of which when so executed and all of which together shall constitute one and the same Agreement. Delivery of executed counterparts may be delivered by or facsimile transmission. PAGE 10

12 DESIGNATED CAREGIVER AGREEMENT EXECUTION Parents/Legal Guardians By signing below, the Parents or Legal Guardians (as applicable) confirm that they have read the Agreement and agree to be bound by it in all respects: Mothers Name: Fathers Name: Mothers Signature: Fathers Signature: Designated Caregiver By signing below, the Designated Caregiver confirms that they have read and understood the Agreement and agrees to be bound by it in all respects: Student Name: Student Signature: School By signing below, the authorised signatory of the School confirms that they are authorised to sign on behalf of the School, and confirms that the School will be bound by the Agreement in all respects: School Representative: Signature: PAGE 11

13 APPLICATION CHECKLIST Immigration Full details of visa and permit requirements, advice on rights to employment in New Zealand while studying, and reporting requirements, are available through the New Zealand Immigration Service, and can be viewed on their website at YOU MUST INCLUDE THE FOLLOWING WITH YOUR APPLICATION FORM OR IT WILL NOT BE ACCEPTED: A photocopy of your current passport Translated copies of your academic results for the last 2 years Photocopy of current insurance policy (if you do not need us to provide you with one) A photocopy of your designated caregiver/s passport (and visa/s) Please send completed application forms to POST: Avondale College intl@avcol.school.nz Attn: International Department Victor Street Avondale Auckland 1026 NEW ZEALAND Information throughout this document is requested in order to provide the school with sufficient information to enable it to make proper contact with parents and to enable the school to comply with such legitimate requests for statistical information as may be required. This information will not be used for any purposes other than those required by the school. It will not be handed on to any other agency except as may be required by law. The information will be stored appropriately. Parents are advised of their right to see this information at any time. They are encouraged to use their legal right to request that it be updated and corrected should circumstances change. Such changes will be made on receipt of the new information in writing from a parent.

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