Apply Online

Student Details

Family Name

First Name

Middle Name(s)

Preferred Name

Date of birth

Please attach a photocopy of your son’s birth certificate or send by post to the school office.

Birth Certificate

We would like our son to have a place at Medbury in

Year (Level)

In the year (eg. 2019)

Day Boy

Boarder

Regular

International

NZ Residency

Country of Birth

Religious Denomination

Present School or Preschool

Year Level at present

Medical history, allergies, illnesses or conditions, including disabilities (if any)

Identified specific learning behavioural difficulties and requirements (if any)

Parent/Guardian 1

Parent/Guardian 1 Surname

Parent/Guardian 1 First name

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Mobile

Parent/Guardian 1 Business Phone

Parent/Guardian 1 Email

Parent/Guardian 1 Occupation

Parent/Guardian 1 Address (physical)

Do you have another son/s already at (or who previously attended) Medbury? If yes, please provide name/s.

Do you have any other son/s expecting to attend Medbury in the future? If yes, please provide name/s, date of birth and the year when they expect to begin at Medbury.

Are Father or Grandfather Old Boys? If yes, please provide full names and leaving years

Any other previous association with Medbury?

How did you hear about Medbury?

Parent/Guardian 2

Parent/Guardian 2 Surname

Parent/Guardian 2 First Name

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Mobile

Parent/Guardian 2 Business Phone

Parent/Guardian 2 Email

Parent/Guardian 2 Occupation

Parent/Guardian 2 Address (physical)

Parent/Guardian 2 Address (postal, if different from above)

International Foreign Fee Paying Students only

Nationality

First Language

Language spoken at home

Passport No

Please attach a photocopy of your son’s passport for verification of the above information.

Declaration

I/We declare that the information supplied on this Application Form is true and correct.

Parent's/Caregiver's Name (Digital Signature)

NB: The application form should be 'signed' by both parents, or all designated caregivers or guardians for regular or international students. By entering your names above you are 'signing' the application form online.

Application Fee

A non-refundable application fee of $150.00 must be submitted with this Application Form in one of the following ways:

Please select your method of payment

Cash

Cheque payable to the Medbury School Trust Board

Internet Banking – Account Name: Medbury School Trust Board

Account Name: Medbury School Trust Board
Bank & Account Number: ASB 12-3148-0026104-00
Swift Code: ASBBNZ2A (International students only)

Please identify your payment in the details that will appear on our statement with your son’s name, his entry level and year. e.g. James Smith Y6 2015

* - Required fields

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