Holiday Programme April 2020 Enrolment Form
Please complete following form to enrol your child for Whatawhata School Holiday Programme.
Childs Name: *
Date of Birth: *
MM
/
DD
/
YYYY
Gender *
Required
Address: *
Parent/Guardian Name. *
Relationship to Child. *
Mobile Number. *
Work Number. *
Email Address. *
Alternative Emergency Contact and Phone Number. *
Additional persons that can collect your child. *
Person/s who are not permitted to collect your child. *
Other Details/instructions. eg, any medical conditions or allergies, special diet. *
Use of photos, videos etc for website and social media. *
Authorisation Agreement in giving consent for my child to participate in the planned activities, as well as any replacement activities - I agree to the following conditions: *
Required
Declaration
Enrolment Details - Please tick days that you would like to enrol your child.
Please Tick
Tuesday 14 April
Wednesday 15 April
Thursday 16 April
Friday 17 April
Monday 20 April
Tuesday 21 April
Wednesday 22 April
Thursday 23 April
Friday 24 April
Clear selection
Submit
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