(09) 521 0009
info@barfootstadium.co.nz
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Home
Upcoming Events
GABBS Book Fair
Venue Hire
Wedding Venue
Events Venue
Meeting Rooms
Sports Venue
Documentation
What's Here
Futsal / Football
Basketball
Martial Arts
Volleyball
Ultimate Frisbee
Fitness and Health
Children's Activities
Preschool
After School
Holiday Programme
Children's Parties
Online Forms
Gallery
About Us
East City Community Trust
Management Team
Feedback
Our Partners
Contact Us
(09) 521 0009
After School Enrolment
Please complete the following form for after school enrolment
*
Indicates required field
Parent /Guardian Information
Full Name
*
Address
*
Phone (Daytime)
*
Phone (Evening)
*
Email
*
Child's Information
Full Name
*
D.O.B
*
dd/mm/yyyy
Gender
*
Male
Female
Ethnicity
*
Commencement Date
*
dd/mm/yyyy
School Attended
*
Classroom
*
Teacher's name
*
Days Required
*
Monday
Tuesday
Wednesday
Thursday
Friday
Family Doctor
*
Family Doctor Phone
*
Health Record
*
Please specify allergies and ailments (e.g. asthma, bee stings, food, penicillin and epilepsy), medical conditions, and assistance required.
Medication (to be provided by parent/guardian)
*
Description of Medication
*
Dosage
*
Is this to be administered by the After School Programme Staff?
*
Yes
No
Is there any other information the Programme should be aware of?
*
Emergency Contact 1
Full Name
*
Address
*
Phone (Daytime)
*
Phone (Evening)
*
Emergency Contact 2
Full Name
*
Address
*
Phone (Daytime)
*
Phone (Evening)
*
Other Authorised Adults to Pickup Children
Full Name
*
Phone Number (Home)
*
Phone Number (Work)
*
Phone Number (Mobile)
*
Relationship to Child
*
Other Authorised Adults to Pickup Children
Full Name
*
Phone Number (Home)
*
Phone Number (Work)
*
Phone Number (Mobile)
*
Relationship to Child
*
Terms and Agreement
*
I have read the terms & agreement and acknowledge that ASB Stadium Staff will run the After-School Programme.
View "
Terms and Agreement
" for After School Programme
Submit
