(09) 521 0009
info@barfootstadium.co.nz
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July Holiday Programme
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About Us
East City Community Trust
Management Team
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Contact Us
Home
Upcoming Events
Auckland Gi Winter Series
Born to Fight 5
Dance with the Fabulous Gypsies
Fit Hop Mid-Winter Mixer
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
July 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:
8th - 12th July
*
Monday 8th
Tuesday 9th
Wednesday 10th
Thursday 11th
Friday 12th
15th - 19th July
*
Monday 15th
Tuesday 16th
Wednesday 17th
Thursday 18th
Friday 19th
Please tick the required days for each Aftercare:
8th - 12th July
*
Monday 8th
Tuesday 9th
Wednesday 10th
Thursday 11th
Friday 12th
15th- 19th July
*
Monday 15th
Tuesday 16th
Wednesday 17th
Thursday 18th
Friday 19th
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
