ACCEPTANCE OF NEW ZEALAND CAREGIVERS TERMS OF RESPONSIBILITIES FOR INTERNATIONAL STUDENTS

STUDENT DETAILS

Family Name:   _________________________________________________________ Given Name:   _________________________________________________________ Date of Birth:   _________________________________________________________ Form Applying For:   _________________________________________________________

NEW ZEALAND CAREGIVER DETAILS

Family Name   _________________________________________________________ Given Names:   _________________________________________________________ Title [circle]:       Mr / Mrs / Miss / Ms Occupation:   _________________________________________________________ Work Place:   _________________________________________________________ Address:   _________________________________________________________ Telephone: ________________________________________________ (Home)   ________________________________________________(Work)   ________________________________________________(Mobile) Fax:   _________________________________________________________ E-mail:   _________________________________________________________ Additional emergency contact: _________________________________________________(Name)   _____________________________________________(Telephone)

As the parents of the above student do not reside in New Zealand, I agree to comply with the responsibilities of a caregiver as outlined in Edgewater College's student profile form. I guarantee that I will ensure the good behaviour of the student for the complete period of enrolment and that I will be readily available to work with the college, should any issue occur. I agree to inform Edgewater College if any of the above details change. Signed ................................................................................................. Date ....................................................................................................