Name your child is known by

Preferred name

First Name

Last Name

Child's date of birth *

MM

DD

YYYY

Copy of official identity verification document collected by staff

Please select the documentation you have provided to the staff at Little Star Montessori House of Children.

NZ Birth Certificate

NZ Passport

Foreign Birth Certificate

Foreign Passport

Other

Child’s Primary Residential Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Proposed date of commencement at Little Star Montessori *

MM

DD

YYYY

Legal Guardian

Mother - Please input all information belonging to this legal guardian below

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Legal Guardian

Father - Please input all information belonging to this legal guardian below

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Doctor's name

First Name

Last Name

Immunisation Record provided to Little Star Montessori

Please email immunisation record to littlestarmontessori@xtra.co.nz or give one of the staff at Little Star Montessori a copy of your child's records.

Yes - Provided

No - Not provided

Date of enrolment

MM

DD

YYYY

Choice of Days

Prior to commencement we will endeavour to accommodate your request but do not guarantee to offer the times you have requested below. Please Note: 20 hours ECE is for up to six hours per day, up to 20 hours per week and there must be no compulsory fees when a child is receiving 20 Hours ECE funding. Times Enrolled 8:45am – 3:30pm

Monday

Tuesday

Wednesday

Thursday

Friday

For 20 hours ECE fill out boxes below with the days attended

Monday

Tuesday

Wednesday

Thursday

Friday

Effective Date of Change for 20 hours ECE:

MM

DD

YYYY

20 hours ECE Attestation

Is your child receiving 20 hours ECE for up to 6 hours per day, 20 hours per week at this service ?

Yes

No

Is your child receiving 20 hours ECE at any other services ?

Yes

No

Where did you first hear about Little Star Montessori House of Children?

Through the ‘grapevine’

Through a child attending this school

Through a relative

From the suburban newspapers

From the telephone directory

The road sign

Recommended by a school (Name of school)

Montessori Aotearoa New Zealand (MANZ) website

Website search eg. Google