Kidzones Holiday Programme Enrolment

Holiday Programme Enrolment Form

Kidzones Location

How many children would you like to register?

Child 1 - First Name

Child 1 - Last Name

Child 2 - First Name

Child 2 - Last Name

Child 3 - First Name

Child 3 - Last Name

Child 4 - First Name

Child 4 - Last Name

Your Email

Your Address

Home Address

Contacts - People Authorized to Collect Your Children

How Many Authorised Parents or Caregivers

First Name

Last Name

Phone Number Authorised Caregiver 1

First Name 2

Last Name 2

Phone Number Authorised Caregiver 2

First Name 3

Last Name 3

Phone Number Authorised Caregiver 3

First Name 4

Last Name 4

Phone Number Authorised Caregiver 4

Please note, we are legally required to have the name and phone number of two emergency contacts on file.

The emergency contacts need to be someone other than a parent/caregiver.

Emergency Contact 1 - Name (not a parent/caregiver)

Emergency Contact 1 - Phone Number

Emergency Contact 2 - Name (not a parent/caregiver)

Emergency Contact 2 - Phone Number

Doctor

Is there anything else we should know about in order to take good care of your child/children?

To check the NZ school holiday dates: Click Here

Required Booking Dates - please enter your required dates separated by commas, or a range of dates. See example below.

Privacy Act 1993: The information that you have provided is necessary for the safe and effective operation of the programme and will be used for the sole purpose of emergencies, birthdays and health and safety of the children as set out in the Policies and Procedures. If you have any questions regarding the programme, Complaints, Code of Behaviour and/or the Prevention of Child Abuse Policies etc please refer to the Programmes Policies and Procedures, which are available upon request.

All information about individuals is available to them for review at any time. As the monitoring agency for OSCAR services, Child Youth and Family may require access to this enrolment information

I give permission for my child to participate in all organized trips as advertised in the programme itinerary. I have received all the relevant information.

Yes

I give permission for my child to participate in unadvertised, low-risk walks away from the school in the local environment eg. Parks and Shops.

Yes

I give permission for my child to swim in the School pool whilst supervised by Kidzone staff.

Yes

I give permission for the supervisor to arrange urgent medical treatment for my child at my cost.

Yes

Photographs of my child/ren may be used for genuine publicity purposes of this programme. They may include hard copy and internet.

Yes

I give permission for Kidzone staff to sign my child in/out of the programme. I will notify them by 9.30am if they are not attending.

Yes

Medical Permissions

I give permission for staff to administer first aid and to seek emergency treatment if necessary.

Contract Agreement

I have read and agree with the Kidzone Contract.

Click here to read the Kidzones Holiday Programme Contract

Kidzones Holiday Programme Application Form