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REGISTRATION FORM
This is the registration form for the Connecting Communities April FREE School Holiday Programme.

For all the information you need about the holiday programme, please head to www.connectingcommunities.org.nz/school-holiday-programme or contact cherie@connectingcommunities.org.nz

Email address *
Parent/Caregiver's name *
Your answer
Phone number *
Your answer
Address *
Your answer
How many children are you registering? *
Your answer
What school(s) do your children attend?
Your answer
Child 1 - Full name *
Your answer
Child 1 - Age
Your answer
Child 2 - Full name
Your answer
Child 2 - Age
Your answer
Child 3 - Full name
Your answer
Child 3 - Age
Your answer
Child 4 - Full name
Your answer
Child 4 - Age
Your answer
What days would you like your child(ren) to attend? *
Required
Please name any other people who may pick up your children
Your answer
Do you give permission for your child to walk home from the programme by themselves?
Is there anything we need to know about your child to help us look after them and/or does your child(ren) have any medical conditions (asthma, allergies, dietary, other) and/or will they require medication at the programme?
Your answer
I am happy for photos/videos of my child to be used for marketing or reporting purposes?
Any other information you would like us to know?
Your answer
Please complete the captcha before submitting the form.
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