(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
Holiday Program Enrolment
Please complete the following form for holiday program 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
Commencement Date
*
dd/mm/yyyy
School Attended
*
Please tick the required days for the Holiday Club:
*Please note dates not listed are due to program being full or unavailable. Please email to get on the waiting list for Wednesday 3rd and Wednesday 10th
1st - 5th October
*
Monday 1st
Tuesday 2nd
Thursday 4th
Friday 5th
8th - 12th October
*
Monday 8th
Tuesday 9th
Thursday 11th
Friday 12th
Please tick the required days for each Aftercare:
1st - 5th October
*
Monday 1st
Tuesday 2nd
Thursday 4th
Friday 5th
8th - 12th October
*
Monday 8th
Tuesday 9th
Thursday 11th
Friday 12th
Family Doctor (Put NA if not available)
*
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 Holiday 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 Holiday Programme.
View "
Terms and Agreement
" for Holiday Programme
Submit
