Untitled Document

Enrolment Form

Kiwi English Academy Ltd

2F 27 Davis Crescent,Newmarket, Auckland, New Zealand
P O Box 113-042 Newmarket, Auckland, New Zealand
Ph : +64 9 5244711
Fax : +64 9 5249010
Email : admin@kiwienglish.co.nz

Personal Details

Family Name:

First Name:

Sex:

Male

Female

Date of Birth:

Passport No:

Expiry Date:

Visa Type:

Study

Visitor

Working Holiday

Other (please specify)

Home Address:

Country:

Home Phone:

Mobile number:

Fax Number:

Email Address:

Nationality:

First Language:

Emergency Contact (this MUST be completed for all students)

Name:

First Language:

Can speak English?

Yes

Address:

Phone Number:

Email:

Contact details of Parents for Students under 18 (this MUST be completed for all students under 18)

Mother's Name:

Father's Name:

Address:

Phone:

Fax:

Email:

Are there any medical, physical or psychological conditions we should be aware of? Please provide details below (if none, please state ‘none')

Course & Campus Details

Please refer to the Courses page for full Course Details.

Please select the course and elective

Senior (18+ years)

Intensive Courses
(25 hours per week)

Standard Courses
(20 hours per week)

General English Plus
(choose one Intensive Elective)

General English Plus

Academic Preparation

Conversation

IELTS Preparation

Internship

TOEFL / TOEIC Preparation

(please specify)
Other

Cambridge FCE / CAE Preparation

Junior (11 - 18 years)

Intensive Courses
(25 Hrs per wk)

Other Courses

General English Plus High School Preparation

English Plus Activities

General English Plus Conversation

Kiwi Buddy

Special Programmes (Junior and Senior students)

Please specify programme

Starting Date:

No of Weeks:

Do you want to enter a New Zealand:
High School	Polytechnic	University

How did you hear about Kiwi English Academy?

Accommodation

*Please note that all students under 18 at a High School Preparation Campus must live in a Kiwi English Academy approved Homestay.

Homestay

Hostel

Apartment

Not required

Start Date:

End Date:

If you require a Homestay, please answer the following questions:

Yes

Do you smoke?

Do you object to dogs/cats in your home?

Are you allergic to animals?

If yes, give details:

Is there any food you cannot eat?

If yes, give details:

Do you suffer from any medical conditions?

If yes, give details:

Do you require any religious observances?

If yes, give details:

Please list your hobbies and/or interests:

Do you have any other homestay requirements?

If yes, give details:

If you do not require a homestay and have made other arrangements for accommodation, please complete the information requested below:

Address:

Phone Number:

Other Number:

Start Date:

End Date:

Airport Pickup

Airport pickup required?	Yes	No
Flight number:
Arrival date and time:
Airport dropoff required?	Yes	No
Flight number:
Departure date and time:

Please provide flight details even if pick up or drop off is not required

Insurance

All international students are required by law to have appropriate current medical and travel insurance.

	Please organise it for me – OR -
	I am able to provide proof of insurance cover that meets the above requirements

Guardianship

We require guardianship for all students at our High School Campus.

Do you require our Guardianship service?	Yes	No
Do you have a Guardian in Auckland? (If yes, please fill in details below)	Yes	No

Name:

Address:

Phone number:

Email:


I, the student, declare that the information provided on this form is true, complete and correct. I undertake to inform Kiwi English Academy Ltd. of any changes to the information contained in this application.
I agree that this enrolment form, assessment information, achievement reports and attendance records can be shown to relevant persons and authorities in accordance with New Zealand law.
I have read and understood the terms and conditions as written below.
Statement of Parent/Guardian if student under 18 (mandatory)
I have read and understood the terms and conditions as written below and give consent for my dependant to attend Kiwi English Academy.

Registered as a private training establishment by the New Zealand Qualifications Authorities pursuant to the Education Amendment Act 1990.

Terms and Conditions

The following information is important. Please ensure that you read and understand it.

Refunds will only be made in accordance with the following policy:

All cancellations must be in writing

Before commencement of the course
1. If notification of cancellation is received in writing before commencement of study, Kiwi English Academy will refund all homestay fees and tuition fees, less the enrolment fee and the accommodation placement fee. Any application for a refund must be accompanied by the original receipts and "Offer of Place". When the refund is made, Kiwi English Academy will advise New Zealand Immigration Service (NZIS) that the "Offer of Place" has been cancelled.
After course commencement
1. For courses of up to and including four weeks and six days. If notification of cancellation is received within the first two days of the course, the student will be refunded 50% of the course fees.
2. For courses of five weeks or more but less than 13 weeks. If notification of cancellation is received within the first five days of the course, the school will retain 25% of the course fees and refund the balance to the student.
3. For courses of 13 weeks or more. If notification of cancellation is received within 8 days of course commencement the student will be refunded all tuition fees less 10% or $500, whichever is the lesser.
4. No refund of tuition fees will be given once 8 days have lapsed from the commencement of the course.
Refunds will be paid:
1. In New Zealand dollars (NZ$)
2. By cheque sent to:
  1. The applicant’s registered address;
  2. Another institution, if requested in writing with the applicant’s signature, supported by evidence of an "Offer of Place" to another institution; or
  3. Under special circumstances the refund can be paid directly to a nominated bank account.
Cancellation of homestay/alternative accommodation
1. A minimum of one week’s notice is required to either request a homestay change or to cancel homestay.
2. If homestay is cancelled after course commencement, the unused portion of the accommodation fees will be refunded on a fortnightly basis for the duration of the course, less one week’s notice and less the $15.00 per week administration fee.
3. Students studying at the Junior Campus and/or who are under 18 must stay in a Kiwi English Academy approved homestay for the duration of their course.

IMPORTANT - PLEASE INFORM THE STUDENT OF THE FOLLOWING:

Insurance – All international students are required by law to have appropriate current medical and travel insurance.
Fees protection - In accordance with NZQA student fee protection policy (www.nzqa.govt.nz/for-providers/aaa/studentprotection.html ) all student fees are protected by an NZQA approved insurance scheme. For further details please refer to the following website : www.studentcare.biz Kiwi English Academy can arrange for one insurance policy that covers medical, travel and fees protection.
Liability – Kiwi English Academy Ltd. will not be liable for loss, damage or injury to persons, or property, howsoever caused, save where liability is expressly imposed beyond exclusion by statute.
Holidays – Kiwi English Academy Ltd. observes all New Zealand public holidays and closes for the two weeks in which Christmas and New Year are celebrated, and for one week at the end of June as a mid-year break.
Complaints – Kiwi English Academy Ltd. has a complaints process that is easy to understand. This is clearly displayed in every classroom. If a student is still dissatisfied after completing the school’s complaints process, he/she is able to access the formal complaints process of the New Zealand Qualifications Authority in Wellington (refer to the website www.nzqa.govt.nz).
Method of Payment: Please either
1. make your remittance payable to:
  Kiwi English Academy Ltd.
  PO Box 113-042, Newmarket
  Auckland, NEW ZEALAND
  
  or
2. send money directly to:
  ANZ Bank, Papakura Branch
  201 Great South Road
  Papakura, Auckland
  NEW ZEALAND
  Account Name: Kiwi English Academy Ltd.,
  Account Number: 010398 0209487 00
  Swift Code: ANZBNZ22