(09) 521 0009
info@barfootstadium.co.nz
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New Page
Home
Upcoming Events
NZ Grappler Regionals 2018
GABBS Book Fair
Venue Hire
Wedding Venue
Events Venue
Meeting Rooms
Sports Venue
Documentation
What's Here
Futsal / Football
Fitness and Health
Children's Activities
Preschool
After School
Holiday Programme
Children's Parties
Online Forms
Gallery
About Us
East City Community Trust
Management Team
Feedback
Our Partners
Contact Us
New Page
(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:
*Please note dates not listed are due to program being full or unavailable
9th - 13th July
*
Monday 9th
Tuesday 10th
Wednesday 11th
Thursday 12th
Friday 13th
16th - 20th July
*
Monday 16th
Tuesday 17th
Wednesday 18th
Thursday 19th
Friday 20th
Please tick the required days for each Aftercare:
9th - 13th July
*
Monday 9th
Tuesday 10th
Wednesday 11th
Thursday 12th
Friday 13th
16th - 20th July
*
Monday 16th
Tuesday 17th
Wednesday 18th
Thursday 19th
Friday 20th
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 ASB Stadium Staff will run the Holiday Programme.
View "
Terms and Agreement
" for Holiday Programme
Submit
