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info@barfootstadium.co.nz
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2021 December Xmas & 2022 January Summer Holiday Programmes
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Home
COVID-19
Upcoming Events
GABBS Book Fair
Venue Hire
Events
Weddings
Sports
School Ball
Meeting Rooms
Documentation
Terms & Conditions
Clubs & Casual Booking Form
Event Enquiry Form
What's Here
Martial Arts
Futsal/Football
Basketball
Volleyball
Dance/Performance
Ultimate Frisbee
Fitness and Health
Children's Activities
Preschool - Kohi Learning Centre
After School
Holiday Programme
2021 December Xmas & 2022 January Summer Holiday Programmes
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
*
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?
*
Nationality:
Please tick the required days for the Holiday Club:
Please tick the required days for each Aftercare:
Fri 17th Dec - Thur 23rd Dec
*
Friday 17th
Monday 20th
Tuesday 21st
Wednesday 22nd
Thursday 23rd
Aftercare 3pm-6pm:
*
Friday 17th
Monday 20th
Tuesday 21st
Wednesday 22nd
Thursday 23rd
Aftercare 3pm-6pm:
*
Monday 10th
Tuesday 11th
Wednesday 12th
Thursday 13th
Friday 14th
Mon 10th Jan - Fri 14th October
*
Monday 10th
Tuesday 11th
Wednesday 12th
Thursday 13th
Friday 14th
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
