(09) 521 0009
info@barfootstadium.co.nz
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December 2019/ January 2020 Holiday Programme
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Home
Upcoming Events
GABBS Book Fair
Gabriel Sater - Brazil and Aotearoa Show 2020
Marians Thaala Live in Concert
Venue Hire
Weddings
School Ball
Events
Meeting Rooms
Sports
Documentation
Booking Confirmation Form
Event Enquiry Form
What's Here
Futsal / Football
Basketball
Martial Arts
Volleyball
Ultimate Frisbee
Fitness and Health
Children's Activities
Preschool
After School
Holiday Programme
December 2019/ January 2020 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
School Attended
*
Please tick the required days for the Holiday Club:
19th - 20th December
*
Thursday 19th
Friday 20th
13th - 17th January
*
Monday 13th
Tuesday 14th
Wednesday 15th
Thursday 16th
Friday 17th
20th - 24th January
*
Monday 20th
Tuesday 21st
Wednesday 22nd
Thursday 23rd
Friday 24th
28th - 31st January
*
Tuesday 28th
Wednesday 29th
Thursday 30th
Friday 31st
Please tick the required days for each Aftercare:
19th - 20th December
*
Thursday 19th
Friday 20th
13th- 17th January
*
Monday 13th
Tuesday 14th
Wednesday 15th
Thursday 16th
Friday 17th
20th - 24th January
*
Monday 20th
Tuesday 21st
Wednesday 22nd
Thursday 23rd
Friday 24th
28th - 31st January
*
Tuesday 28th
Wednesday 29th
Thursday 30th
Friday 31st
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
