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info@barfootstadium.co.nz
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Home
COVID-19
Upcoming Events
GABBS Book Fair
Phillip Lam Kickboxing
NHG Rhythmic Gymnastics
Auckland Gi Regonals
Venue Hire
Events
Weddings
Sports
School Ball
Meeting Rooms
Catering Kitchen
Documentation
Terms & Conditions
Clubs & Casual Booking Form
Event Enquiry Form
What's Here
Martial Arts
Futsal & Football
Basketball
Volleyball
Dance & Performance
Ultimate Frisbee
Health & Fitness
Children's Activities
Kohi Learning Centre
Kohi Kids - After-school Club
Kohi Kids - Holiday Programme
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:
Tue 19th Apr- Fri 22nd Apr
*
Tue 19th Apr
Wed 20th Apr
Thu 21st Apr
Fri 22nd Apr
Tue 26th Apr - Fri 29th Apr
*
Tue 26th Apr
Wed 27th Apr
Thu 28th Apr
Fri 29th Apr
Aftercare 3pm-6pm
*
Tue 19th Apr
Wed 20th Apr
Thu 21st Apr
Fri 22nd Apr
Aftercare 3pm-6pm
*
Tue 26th Apr
Wed 27th Apr
Thu 28th Apr
Fri 29th Apr
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
*
View "
Terms and Agreement
" for Holiday Programme
Terms and Agreement
*
I have read the terms & agreement and acknowledge that ECCT Staff will run the Holiday Programme.
Submit
