Appin Park Farm School Holiday Program Registration Form

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Appin Park Farm School Holiday Program Registration Form

Join Melissa, our amazing Farm School teacher, for an outdoors, nature based school holiday program at our Farm School, Appin Park, Silverdale in January.

DATES: January 7 - 23, 2025

DAYS: Tuesday, Wednesday, Thursday

COST: $80 per session

AGES: for children aged 5-12 only

ADDRESS: Appin Park Farm School - 2095a East Coast Road, Silverdale (1kms from PaknSave)

Children need to be dropped off at and picked up from Appin Park, Silverdale.

By completing this form I agree to the terms and conditions attached.

Yes, Please enrol my child in the Appin Park Farm School Holiday Program. I have read and agree to the terms and conditions. *

Yes

Child's First Name *

Child's Surname *

Child's Date of Birth *

YYYY

Please indicate the days you wish your child/ren to attend

Wednesday

Thursday

January 15-16

January 22-23

Please describe in detail any allergies or known medical conditions. If none, state "NIL" *

I give permission for the program leaders to seek medical support, if needed, for my child and I agree to pay any or all medical expenses that may arise.

Yes

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Please describe any learning or behavioural challenges or needs that your child has.

Please give the first and surname of any other adult who you give permission to pick up your child from this program

Your Full Name (First and Surname) *

Your Phone Number *

Your email address - please double check spelling *

Your home address *

Next of Kin / Emergency contact for child (please give phone and email) *

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This form was created inside of Kakapo Creek Children's Garden.

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