09 418 2770
manager@minimee.co.nz
6 Bank Street, Hillcrest, Auckland 0627, New Zealand
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Enrollement Form
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Enrollement Form
Child Details
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Enrollement
Child Details
Preferred First Name
Preferred Last Name
Official First Name
Child's Date of Birth
Child's Gender
Male
Female
Residential Address
Languages Known
Ethnicity
How did you hear about us?
PARENT DETAILS
Title
Relationship
First Name
Last Name
Mobile
Daytime Phone
Evening Phone
Address
Occupation
EMERGENCY CONTACTS
Add emergency contact(s) other than Parent/Guardian - must be able to pickup your child.
Title
Relationship
First Name
Last Name
Mobile
Daytime Phone
Evening Phone
Address
ADDITIONAL CONTACTS
Do you have any additional people that can pickup your child? If so, please enter them here and press Next when you are done.
Title
Relationship
First Name
Last Name
Mobile
Daytime Phone
Evening Phone
Address
PICKUPS PROHIBITED BY
Important
- are there people who specifically cannot pickup your child? If so, please enter their details here.
Title
Relationship
First Name
Last Name
Mobile
Daytime Phone
Evening Phone
Address
HEALTH
Child's Doctor
Doctor Name
Medical Centre Name
Doctor Address
Doctor Phone
HEALTH
Childhood Diseases/Diagnosis
Allergies
To what period / stage is your child fully immunised up to ?
Please select:
Not immunised
0 Weeks
6 Weeks
3 Months
5 Months
12 Months
15 Months
4 Years
Special Diet
Does Not Want Immunisations
MEDICINES
Category I Medicines
Category III Medicines
PERMISSIONS
Please indicate below whether you give permission for your child to:
Can Attend Walks
Can See Health Nurse
Can Use Image For Newsletters
Can Use Image For Notices
Can Use Image For Study
Can Be Taken To Medical Centre
Can Use Image For Facebook
Can Use Image For Newspaper
Can Use Image For Planning
ENROLLEMENT
Please choose the dates and days below. Note the service may require you to enrol a certain number of days.
Start date
End date
Minimee Early Childhood Education is closed on all Statutory Holidays. Please speak to the centre administrator for more details.
