"Limestone Rangers" - Sign up Form        (Term 3 / Oct Holidays 2019)
Please complete this form if you want to book your child(ren) in for the Limestone Rangers School Holiday programme (Term 3 holidays in October 2019).  FYI: We are also running "Kid's Outdoors - Huanui" Holiday Programme during these holidays. Here's the link if you wish to book: https://forms.gle/wKEx9oqpCmezD61A8 . If you would like to book additional Limestone Rangers days in the future, just email safeoutdoorsnz@gmail.com with the additional dates and I will simply transfer your information.
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Email *
Parent name *
Parents contact phone number *
Alternative Emergency contact number (different than above) *
How many children are you signing up? *
What is your child / children's full name(s)? *
How old are they? *
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
What date(s) are you wanting to attend in the first week of October?
Wed 2nd (1 spot left)
Thurs 3rd (sorry full)
Oct
What dates are you wanting to book in the second week of October?
Wed 9th (sorry full)
Thurs 10th (sorry full)
Oct
Does your child have any medical conditions we should know about? - (please include for each child: symptoms, treatment and emergency response if necessary) *
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). *
Does your child have any food allergies we should know about? (please include a description for each child if necessary) *
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/limestone-rangers-whanga *
Required
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 (+ $7.50) per person
3.45 - 4pm (+ $15) per person
4 - 4.15pm (+ $22.50) per person
Onerahi Playground
Please write below a brief summary of what you are paying for e.g:                                                   (1x child / single day = $55)        or                        (1 x child / 2 x days + $10 late pick up both days = $130) *
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 "LR" followed by your child's last name in the reference. *
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