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info@barfootstadium.co.nz
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2020 December Christmas - January Summer Holiday Programme
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Home
COVID-19
Upcoming Events
GABBS Book Fair
Magical Fiesta Auckland Zumba
Fittest Mum Finals Competition
No-Gi Auckland Regionals
Venue Hire
Events
Weddings
Sports
School Ball
Meeting Rooms
Documentation
Terms & Conditions
Clubs & Casual Booking Form
Event Enquiry Form
Booking Confirmation Form
What's Here
Martial Arts
Futsal / Football
Basketball
Volleyball
Dance/Performance
Ultimate Frisbee
Fitness and Health
Children's Activities
Preschool
After School
Holiday Programme
2020 December Christmas - January Summer Holiday Programme
Children's Parties
Online Forms
Gallery
About Us
East City Community Trust
Management Team
Feedback
Our Partners
Jobs
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
Nationality:
School Attended
*
Family Doctor (Put NA if not available)
*
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?
*
Please tick the required days for the Holiday Club:
Please tick the required days for each Aftercare:
Wed 16th Dec - Wed 18th Dec
*
Wednesday 16th
Thursday 17th
Friday 18th
Aftercare 3pm-6pm:
*
Wednesday 16th
Thursday 17th
Friday 18th
Mon 21st Dec - Wed 23rd Dec
*
Monday 21st
Tuesday 22nd
Wednesday 23rd
Aftercare 3pm-6pm:
*
Monday 21st
Tuesday 22nd
Mon 11th Jan - Fri 15th Jan
*
Monday 11th
Tuesday 12th
Wednesday 13th
Thursday 14th
Fri 15th Jan
Aftercare 3pm-6pm:
*
Monday 11th
Tuesday 12th
Wednesday 13th
Thursday 14th
Friday 15th
Mon 18th Jan - Fri 22nd
*
Monday 18th
Tuesday 19th
Wed 20th
Thur 21st
Fri 22nd
Aftercare 3pm-6pm:
*
Monday 18th
Tuesday 19th
Wednesday 20th
Thursday 21st
Friday 22nd
Mon 25th Jan - Fri 29th Jan
*
Monday 25th
Tuesday 26th
Wednesday 27th
Thursday 28th
Friday 29th
Aftercare 3pm-6pm:
*
Monday 25th
Tuesday 26th
Wednesday 27th
Thursday 28th
Friday 29th
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 ECCT Staff will run the Holiday Programme.
View "
Terms and Agreement
" for Holiday Programme
Submit
