Balmacewen Intermediate School - Dunedin, New Zealand

International Students

Online Enrolment Form - International Students

Balmacewen Intermediate School

44 Chapman Street, Dunedin, New Zealand.
Telephone: (03) 466-7251
Facsmile: (03) 466 7252

NAME: (Surname)
(Given Names)

GENDER:

DATE OF BIRTH:

COUNTRY OF ORIGIN:

LIVING IN NZ WITH:

RELATIONSHIP:
NZ ADDRESS:

HOME PHONE:

MOBILE PHONE:

EMERGENCY CONTACT:
PHONE:

ENROLLED BY (NAME):
RELATIONSHIP:
ADDRESS:
HOME PHONE:
MOBILE:

PASSPORT NUMBER:
EXPIRY DATE:
STUDENT PERMIT NO.:
STUDENT VISA NO.:
DATE OF ENTRY TO NZ:
FIRST LANGUAGE:

ACCOMMODATION:
Where applicable give visa and passport details
PASSPORT NUMBER:
VISA NUMBER:

INTERNATIONAL CONTACT DETAILS
MOTHER'S NAME: (Surname)
(Given Names)
MOBILE:
PHONE:
EMAIL:
ADDRESS:
FATHER'S NAME: (Surname)
(Given Names)
MOBILE:
PHONE:
EMAIL:
ADDRESS:
EMERGENCY CONTACT:

OTHER STUDENT DETAILS? (Please provide details of any medical conditions, allergies, medication etc.)

Application Checklist

o Copy of Passport
o Signed Refund Policy
o Verification of Travel/Health Insurance
o Signed Tuition Agreement

IS THERE ANY OTHER INFORMATION YOU WISH US TO HAVE?

Your Computer Type:

How would you rate this site?

Excellent
Good
Fair
Poor