Nature'sCool - Summer holiday sign up form. 19 / 20
Please complete this form if you want to book your child(ren) in for the Nature'sCool Summer Holiday programme based in Huanui / Glenbervie (Whangarei). FYI: We are also running "Limestone Rangers" Holiday Programme during these holidays. Here's the link if you wish to book:
Note - If you would like to book additional days in the future, just email with the additional dates and I will simply transfer your information (no need to fill in the form again). Thanks so much for your support! Luke & Hilary.
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
If your child is under 6 years of age then they must be accompanied by a (full paying) older sibling or close friend who is 7 years or older- please detail below
Your answer
What date(s) are you wanting to attend in Early Jan? (you can tick more than one)
Mon 6th Jan
Tues 7th Jan (sorry full)
Thurs 9th Jan (almost full)
Fri 10th Jan
What date(s) are you wanting to attend in Mid - Jan? (you can tick more than one)
Mon 13th Jan (sorry full)
Tues 14th Jan (sorry full)
Thurs 16th Jan (sorry full)
Fri 17th Jan
What date(s) are you wanting to attend in late - Jan? (you can tick more than one)
Mon 20th Jan
Tues 21st Jan (sorry full)
Thurs 23rd Jan (2 spots left)
Fri 24th Jan
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)? *
Does your child have any behavioral or learning characteristics that we should know about? (please include a description for each child if necessary). *
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 *
Pick up time & after hours supervision request: Please select the pick up option which applies to you and add the corresponding amount to your total payment in the question below:
3.15 - 3.30pm (no extra charge)
3.30 - 3.45pm (+ $6.50) per person
3.45 - 4pm (+ $13 ) per person
4 - 4.15pm (+ $19.50 ) per person)
4.15 - 4.30pm (+$26) per person
Huanui College
Please write below a brief summary of what you are paying for e.g: 1x child / single day = $45) or (2 x children / single day ) = $90 or (1 x child / 2 x days + $13 late pick up Huanui both days = $113) *
Your answer
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 "NC" followed by your child's last name in the reference. *
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