After School Enrolment

(09) 521 0009 info@barfootstadium.co.nz

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Upcoming Events
Venue Hire
What's Here
Children's Activities
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About Us
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

Barfoot & Thompson Stadium is a multi-purpose indoor facility that is conveniently located less than 10km from Auckland's city centre. With our flexibility and experience we can cater for large or small national and regional events as well as local community activities.

Contact

Phone
(09) 521 0009

Email
info@barfootstadium.co.nz

Address
203 Kohimarama Road, Kohimarama, Auckland 1071 (Selwyn College Grounds)

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After School Enrolment

Parent /Guardian Information

Child's Information

Emergency Contact 1

Emergency Contact 2

Other Authorised Adults to Pickup Children

Other Authorised Adults to Pickup Children

Contact

Events

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