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Day School Student

Applying for a day school is easy.

Simply fill in the form below, submit it and we will be in touch.

If you are human, leave this field blank.

Basic Info

Full name *

Preferred Name

Email Address *

Contact Phone Number *

Contact Address *

Country

City

Gender *

Male

Female

Marital Status *

Date of Birth *

Age *

Place of Birth *

Country

Occupation *

Country

Please state which school you are applying for *

Start Date *

Emergency Information

In case of emergency, who do we contact?

Emergency Contact Name *

Relationship *

Address *

Country

City

Phone Number *

Email *

Health Information

Are you presently under a doctor’s care for any condition? *

Yes

Are you taking any prescription medications? *

Yes

Do you have a history of emotional instability or psychiatric treatment? *

Yes

Special diet? *

Yes

Allergies? *

Yes

If yes

MILD

MOD

SEV

Do you have any physical impairments, handicaps, or health conditions that require special attention? *

Yes

If you answered yes to any of the questions above, please explain.

Consent for treatment *

In case of emergency, by clicking "Yes, I agree", I hereby agree to the performance of such treatment, including anaesthesia and surgery, as the attending doctor or physician may deem necessary.

Yes, I agree

Release of Liability *

By clicking "Yes, I agree", I hereby release ACTS School and Youth With A Mission, its staff, agents and volunteer assistants from any liability whatsoever arising out of any injury, damage, death, or loss which may be sustained by said person(s) during the course of involvement with this mission base.

Yes, I agree

Any other useful or relevant information you would like us to know about

You can help make evangelical history.

Here you will learn how to realise your underlying and possibly undiscovered devotion to Christ as a force to be reckoned with!

ACTS SCHOOL

155 Greenpark Road
Lincoln 7674

+64 27 399 4705 Acts Office
office@actsschool.co.nz

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