(09) 521 0009
info@barfootstadium.co.nz
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IT Heavy Hitters 2019
Auckland Champs - Rhythmic (Qualifier)
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Weddings
School Ball
Events
Meeting Rooms
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What's Here
Futsal / Football
Basketball
Martial Arts
Volleyball
Ultimate Frisbee
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Children's Activities
Preschool
After School
Holiday Programme
April Holiday Programme
Children's Parties
Online Forms
Gallery
About Us
East City Community Trust
Management Team
Feedback
Our Partners
Contact Us
Home
Upcoming Events
IT Heavy Hitters 2019
Auckland Champs - Rhythmic (Qualifier)
Venue Hire
Weddings
School Ball
Events
Meeting Rooms
Sports
Documentation
What's Here
Futsal / Football
Basketball
Martial Arts
Volleyball
Ultimate Frisbee
Fitness and Health
Children's Activities
Preschool
After School
Holiday Programme
April 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:
15th - 19th April
*
Monday 15th
Tuesday 16th
Wednesday 17th
Thursday 18th
22nd - 26th April
*
Tuesday 23rd
Wednesday 24th
Friday 26th
Please tick the required days for each Aftercare:
15th - 19th April
*
Monday 15th
Tuesday 16th
Wednesday 17th
Thursday 18th
22nd - 26th April
*
Tuesday 23rd
Wednesday 24th
Friday 26th
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 ECCT Staff will run the Holiday Programme.
View "
Terms and Agreement
" for Holiday Programme
Submit
