INS Accompanying Adult Form

Spouse Details

Name of Spouse(Required)

First Last

Please provide the name of who you are accompanying to the INS.

Your Details

Name(Required)

First Last

Gender(Required)

Male

Female

Date of Birth(Required)

Place of Birth(Required)

City Country

Email(Required)

Time Zone(Required)

Phone(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please include a recent photo of yourself(Required)

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 10 MB.

English Proficiency

Proficiency in oral and written English is necessary for you to participate in the INS.

Is English your native language?(Required)

Yes

No

Spoken English(Required)

Please indicate your ability level

Understanding spoken English(Required)

Please indicate your ability level

Written English(Required)

Please indicate your ability level

Understanding written English(Required)

Please indicate your ability level

Passport information

Passport Number(Required)

Name as shown on passport(Required)

First Middle Last

Country of Citizenship(Required)

Country

Country of Issue(Required)

Country

Date of Issue(Required)

Date of Expiry(Required)

Please include a scan of your passport(Required)

Accepted file types: jpg, jpeg, png, pdf, doc, docx, Max. file size: 10 MB.

Health & Special Needs

How would you rate your overall health?(Required)

Do you have any special medical dietary requirements?(Required)

(eg. Allergy to nuts, celiac, vegetarian, dairy intollerant, etc.)

Yes

No

Please specify(Required)

Life at Orama

Orama Main Building

Our location at Orama is remote and living conditions are basic; shared housing, limited services and no public transportation.

The facilities are located at the bottom of an uphill gravel driveway (a 35-minute brisk walk) and require a reasonable level of fitness to access local amenities.

The nearest village shop is a further 45-minute walk from the mouth of the driveway (Orama has it’s own shop for toiletries, snacks and various sundry supplies).

We view Orama’s isolation as a positive attribute. However...

Do you believe you could live in such a secluded and basic environment for the duration of the school?(Required)

Yes

No

Medical Insurance

It is essential that all participants of the INS have adequate medical insurance coverage for the duration of the school. If you currently have international health insurance please include the details below.

Name of insurance carrier

Policy type

Policy number

Policy Expiration Date

Insurer’s contact phone number

Brief description of coverage

NOTE: Medical insurance is compulsory for all international participants and is also strongly recommended for all New Zealand participants. If you do not currently have insurance please wait until you are accepted for the school before purchasing a policy.

Medical Treatment

Are you currently receiving treatment from a doctor for any condition?(Required)

Yes

No

Please elaborate(Required)

Are you currently taking any medication?(Required)

Yes

No

Please elaborate(Required)

Criminal Record

Do you have a criminal record?(Required)

Yes

No

Please specify(Required)

Have you ever been convicted or accused of a sexual crime?(Required)

Yes

No

Please specify(Required)

Emergency Information

Emergency Contact Name(Required)

In case of emergency please contact:

First Name Last Name

Their relationship to you(Required)

Please specify(Required)

Emergency Contact Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Contact Email(Required)

Emergency Contact Phone(Required)

Emergency Contact Time Zone(Required)