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Enrolment Form


IMPORTANT NOTE FOR STUDENTS UNDER 18 YEARS:

Parents must fill in, sign and fax or email their child's enrollment form to RELA
before their child arrives at the school. click here for under 18 enrollment form

Personal Details

Family Name: Date of Birth: / /
Given Name:   Day / Month / Year
Preferred Name:
Gender: Have you studied at RELA before?:
Passport Number:
Nationality:
Type of Visa: Visa Exp:
Are you a NZ Resident? Are you a NZ Citizen?
Emergency name Emergency Number
Emergency address

Overseas Home Details

Home Address:
Home Country: Home City
Home Phone:    
Home Fax: Home Postal Code:
Home Email:

New Zealand Details

NZ Address:
NZ City NZ Fax:
NZ Phone: NZ Mobile:
NZ Email:

Course Details

Start Date: Day / Month / Year
/ /
Finish Date: / /

Which course do you want to join?

How many hours per week do you want to study?

What is your current level of English?
Why do you want to learn English?
How did you hear about RELA?
Agent's Name (if any):

Accommodation

  Day / Month / Year
First Night: / /
Last Night: / /

Transport

Arrival
I want RELA to arrange transport from
Departure
I want RELA to arrange transport from

Insurance

You must have Travel and Medical Insurance while in New Zealand. This is to meet requirements of the New Zealand government. RELA can buy the insurance through Uni-care for you.
I want RELA to arrange Insurance for me:
Pre-existing conditions will probably not be covered
Do you have a health problem we should know about?
If yes, please state:
Please write your Insurance finish date

Privacy

Rotorua English Language Academy (RELA) collects and stores information from this form to manage the business (including internal reporting and administrative processes) , to comply with the requirements of the Education Act 1989 and other legislation relating to maintenance of official records and accountability for public funding, and to supply information to government agencies and other organisations as set out below. RELA may add your personal details (name, date of birth and residency) to the National Student Index, which is managed by the Ministry of Education.

Supply of information to government agencies and other organisations

RELA supplies data collected on your enrolment to government agencies, including the Ministry of Education, the New Zealand Qualifications Authority, the Tertiary Education Commission, Immigration New Zealand (a branch of the Ministry of Business, Innovation and Employment): for those who are not New Zealand citizens or permanent residents. These agencies use the data supplied by tertiary education organisations to administer the tertiary education system, including allocating funding', develop policy advice for government and conduct statistical analysis and research. The Ministry of Education may supply data collected on this form to Statistics New Zealand for the purposes of integrating data with data collected by other government agencies, subject to the provisions of the Statistics Act 1975.  Integrated data is used for the production of official statistics, to inform policy advice to government and for research purposes. When required by law, RELA releases information to government agencies such as the New Zealand Police, Department of Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC). Information collected on this form may be supplied to other educational organisations for the purpose of verifying academic records.

I give permission for any photos taken of me to be used by RELA for marketing purposes on their website, in their brochure, on their Facebook pages and on Instagram.

Student Fee Trust Account Application Form (Agent Authority)

  1. All students enrolling in a course with total fees of $500 or more are required to establish a Student Fee Trust Account by completing a Student Fee Trust Account Application Form (Application Form).
  2. The Application Form must be signed by a student (or a student's Guardian if the student is under 18 years old) and returned to RELA with this Enrolment Form.
  3. If RELA does not receive a signed Application Form with this Enrolment Form and a student is under 18 years old then by signing this Enrolment Form the student's guardian agrees to appoint RELA as their agent to sign the Application Form on their behalf
  4. This Agent Authority is limited as outlined above and does not permit RELA to sign any withdrawal or refund form on behalf of a student or student's guardian.

Declaration

I declare to the best of my knowledge all the information supplied on, and with this enrolment form is true and complete, I agree to abide by the conditions described above, and I consent to the disclosure of personal information as described above. I agree to the
Conditions of Enrolment of Rotorua English Language Academy.

I have read and I accept the conditions of enrolment
Date:
   
 

* Once your enrolment form has been submitted we will contact you with an invoice and information about your course of study.