Nature'sCool - Sign Up Form - Term 4 2019
Please complete this form if you want to sign your child(ren) up for the Nature'sCool Term 4 programme 2019. This programme is Ten weeks in total and begins 16th October. This form is for the Full day or Half day. For full details please visit: www.safeutdoors.co.nz/details .

Please note that the maximum number of participants is (16) at any one time and the minimum number is (8). Spaces will be issued on a first paid / first served basis with Full day participants also taking priority. Part payment plans aligning with the Terms & Conditions (2 weeks in advance) qualify in this regard. Information regarding available spaces can be found below. (Please email safeoutdoorsnz@gmail.com if you have any questions).

Email address *
Parent name *
Your answer
Parents contact phone number *
Your answer
Alternative Emergency contact number (different than above) *
Your answer
How many children are you signing up? *
What is your child / children's full name(s)? *
Your answer
How old are they? *
Your answer
Please choose from the following options:
Full day
Half Day (Am)
Half day (Pm)
Wed
Please indicate which other week days will work for you
Wednesday
Row 1
If your child(ren) attend school, please list the name of the school below:
Your answer
Do you require assistance compiling an application for release of your child from school? *
Does your child have any medical conditions we should know about? - (please include for each child: symptoms, treatment and emergency response if necessary) *
Your answer
In the event of an incident / accident or emergency, do you give Safe Outdoors NZ staff permission to administer "over the counter" medication - including paracetamol, antihistamines or Ventolin (blue inhaler) to your child(ren)? *
Please briefly summarize below why this programme will be beneficial to your child - include any behavioral or learning characteristics that we should know about? (We will elaborate and discuss this via email). *
Your answer
Does your child have any food allergies we should know about? (please include a description for each child if necessary) *
Your answer
Media Release: please let us know if you / your child(ren) are comfortable with photos / videos of your child(ren) being used on our social media site(s) and / or our website? *
Authorisation: By ticking "Agree" below, you as a guardian of the child or children (listed above), agree to the terms and conditions as outlined on the website: https://safeoutdoors.co.nz/terms-%26-conditions *
Required
Full day: Pick up time & after hours supervision request: Please select the options which best applies to you. (Prices are 'per child'. Please add the corresponding amount to your total payment in the appropriate question below:
Standard pick up 3.15 - 3.30pm (no charge)
3.30 - 3.45pm (+ $10) per child
3.45 - 4pm (+$20) per child
Full day
Half day: Pick up time & after hours supervision request: Please select the options which best applies to you. Prices are 'per child'. Please add the corresponding amount to your total payment in the question below:
Am Pick up: (Standard) - 11.45am - 12pm (no extra charge)
Am Pick up: 12 - 12.15pm (+$10) per child
Am Pick up: 12.15 - 12.30pm (+$20) per child
Pm Pick up: 3.15 - 3.30pm (no charge)
Pm Pick up: 3.30 - 3.45 (+ $10) per child
Pm Pick up: 3.45 - 4pm (+ $20) per child
Half Day
Please summarize what it is you are paying for below: e.g: 1 x child, full day = $540. or 1 x child, full day (with early full payment discount) = $57 x 9 weeks = $513 + $10 late pick up each day ($90) = $603 *
Your answer
Please indicate below your intended payment schedule: *
Payment: To confirm your child(ren)'s place in the programme - please make a Direct bank transfer to ANZ account: "Safe Outdoors NZ Ltd" - 01-0877-0763805-00. Please put the code "Full" or "Half" followed by your child's last name in the reference.
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