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

Spaces are limited so there is a chance we may not be able to accept all registrations. We will confirm with you by Monday the 2nd of July whether or not you have a place on the programme.

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

Email address *
Parent/Caregiver's name *
Your answer
Phone number *
Your answer
Address *
Your answer
Other contact (in case of emergency). Please provide name and phone number: *
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
Do you give permission for your child to walk home from the programme by themselves?
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? *
Is there any other information you would like us to know eg, custody/access arrangements, cultural/religious needs, behaviour support?
Your answer
In the event of a medical emergency, I give permission for my child to receive treatment *
In order for CCW to provide a free school holiday programme we depend on partner organisations who assist with funding and activities. Wairarapa Bush RFU, is one of our partners, and will be taking registrations and running Rippa Rugby sessions at the school holiday programme. I give permission for my child to be registered with Wairarapa Bush Rugby *
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