(09) 521 0009
info@barfootstadium.co.nz
Home
About Us
Home
COVID-19
Upcoming Events
GABBS Book Fair
Let's Go Garba 2020
Street Swing - The NZ Open 2020
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 September - October Spring Holiday Programme
Children's Parties
Online Forms
Gallery
About Us
East City Community Trust
Management Team
Feedback
Our Partners
Jobs
Contact Us
Home
COVID-19
Upcoming Events
GABBS Book Fair
Let's Go Garba 2020
Street Swing - The NZ Open 2020
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 September - October Spring 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:
28th September - 2nd October
*
Monday 28th
Tuesday 29th
Wednesday 30th
Thursday 1st
Friday 2nd
5th October - 9th October
*
Monday 5th
Tuesday 6th
Wednesday 7th
Thursday 8th
Friday 9th
Please tick the required days for each Aftercare:
28th September - 2nd October
*
Monday 28th
Tuesday 29th
Wednesday 30th
Thursday 1st
Friday 2nd
5th October - 9th October
*
Monday 5th
Tuesday 6th
Wednesday 7th
Thursday 8th
Friday 9th
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
