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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 enrolment form to RELA
before their child arrives at the school. click here for under 18 enrolment 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 collects and stores information from this form to comply with the requirements of the Ministry of Education and New Zealand Qualifications Authority, The information is also used to manage internal administrative processes, and for internal reporting. Information about students may be supplied to, and sought from, other educational institutions for the purpose of verifying academic records.

In addition, when required by statute, Rotorua English Language Academy releases information to Government agencies such as the New Zealand Police, Department of
Justice and the Accident Compensation Corporation (ACC). In signing this enrolment form you authorise such disclosure on the understanding that the Academy will
observe the general conditions governing the release of information, as set out in the Privacy Act 1993. You may see any information held about you and amend any errors in that information.

Fees - In signing this enrolment form you undertake to pay all fees as they become due, and to meet any late fees and collection charges associated with debt recovery.

Rotorua English Language Academy's policy on withdrawal and refund of fees may be obtained from the Academy office.

Rules - In signing this enrolment form you undertake to comply with the published rules and policies of Rotorua English Language Academy with regard to attendance,
academic progress, health and safety and behaviour.

Student Fee Trust Account Application Form (Agent Authority)

A) All students are required to establish a Student Fee Trust Account by completing a Student Fee Trust Account Application Form (Application Form).

B) 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.

C) 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

D) 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.

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

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.