Squiggle Holiday Programme Enrolment Form - 16th - 27th April 2018
Enrol your child into the April Holiday Programme by completing this form. If you have already enrolled in Squiggle before, complete the Re-Enrolment form (which is much briefer!)

Please note that our daily costs are $43/day. If you have more than one child, you will receive a 20% discount. Families who are eligible for WINZ will not be eligible for the discount. There are additional costs for offsite trips.

We will be open during the 16th - 27th April, however we will be closed for ANZAC Day on 25th April 2018.

We will be operating from Waikato Diocesan School (Fairfield).

Our two trip days are Friday 20th April (Mountain Sanctuary Maungatautari - $23.00 additional) and Friday 27th April (Te Awa, Movies - $14.00 additional).

Once you have completed the form, we will send your invoice for payment which must be paid prior to your child attending the programme.

If you are eligible for WINZ/Study Link, please ensure you have approval with WINZ/Study Link prior to enrolling your child/children. You are required to make a 50% deposit before you enrolment can be completed.

Please ensure you have read and agreed to the Disclaimer for enrolling your child/children (www.squiggle.org.nz/disclaimer).

Child's Details
Please complete the following information for your child.
First Name *
Your answer
Surname *
Your answer
Date of Birth *
Gender *
E.g. New Zealander, Maori, Samoan, Fijian, Australian, South African
Your answer
Home Address *
Your answer
School *
Your answer
Emergency Contact Details
In case of an emergency with your child, please provide the contact details for yourself or someone that we can call during the holiday programme hours.
1st Emergency Contact Full Name *
Your answer
Relationship to child *
1st Emergency Contact Mobile/Phone *
Your answer
2nd Emergency Contact Full Name *
Your answer
Relationship with child *
2nd Emergency Contact Mobile/Phone *
Your answer
Health and Special Needs
Please provide any information about your child's health and/or special needs that will enable us look after your child during our care. We need to know as much about your child as possible to make sure we are able to give them quality of care, so please make sure to tell us how we can do this.
Health and/or medical conditions *
Please advise what treatment is required OR what allergies your child has and any medication they are required to take. It may also be helpful to tell us why they need medication. Please state "Nil" if there are no medical conditions nor allergies.
Your answer
Special needs *
Does your child have any special needs, e.g. physical, social, cultural, emotional. To help us take good care of your child/ren, please fill in as much detail as you think we need to know (so there are no surprises). Please state "Nil" if there are no special needs.
Your answer
Un-Authorised Collection
Please advise us who is unauthorised to pick your child up. If listing unauthorised person(s), please provide verified written evidence (e.g. custody, access or protection order) prior to the child commencing the holiday programme.
Full name of UNAUTHORISED person
Please advise who IS NOT authorised to collect your child
Your answer
Relationship to child
Choose how many days your child will be attending the HOLIDAY PROGRAMME. *
Please choose full week option or daily option
Offsite Activities Consent *
From time to time we will hold offsite activities which may require us to use transport or visit venues (e.g. swimming pools, museums). Please advise if you consent to your child attending offsite activities.
Consent to Photo for Film *
From time to time we will take photographs or film children during the programme. We would like to be able to use the photos/films to share with parents and show them what their child has been doing. Please advise if you consent to your child's photo/film being taken and used to share their experiences with their families and whether you consent to your child photo/film being used for marketing/promotional purposes.
Parent/Guardian Details
First Name of Parent/Guardian *
Your answer
Surame of Parent/Guardian *
Your answer
Email *
Your answer
Relationship to child *
Mobile/Phone *
Your answer
Are you applying for WINZ/Study Link subsidies?
If you are eligible for WINZ, please ensure receive approval prior to the programme commencing. You will also need to make 50% deposit before your enrolment can be completed.
Will your child be arriving unaccompanied to the programme (only for children 10 years and over) *
If yes, please advise how they will be coming to the programme, e.g. bus, bike, walking and expected time of arrival and departure
Your answer
Terms and Conditions *
To complete your child's enrolment, you must agree to the programme Disclaimer
How did you hear about Squiggle?
Never submit passwords through Google Forms.
This form was created inside of TriMaori Charitable Trust. Report Abuse - Terms of Service - Additional Terms