Nature'sCool - Sign Up Form - Term 3 2019
Please complete this form if you want to sign your child(ren) up for the Nature'sCool Term 3 programme 2019. This form is for the Full day or Half day. For full details please visit: www.safeutdoors.co.nz/details .

Please note that the maximum number of participants is (16) at any one time and the minimum number is (8). Spaces will be issued on a first come / first served basis. Information regarding available spaces can be found below.  (Please email safeoutdoorsnz@gmail.com if you have any questions).


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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? *
Please choose from the following options:
Full day
Half Day (Am)
Half day (Pm)
Wed (Full) pending confirmation
Thurs
Friday
Clear selection
Please indicate which other week days will work for you
Monday
Tuesday
Wednesday (put me on waiting / cancellation list)
Thursday
Friday
Row 1
If your child(ren) attend school, please list the name of the school below:
Do you require assistance compiling an application for release of your child from school under Section 25b of the Education Act? *
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)? *
Please briefly summarize below why this programme will be beneficial to your child - include any behavioral or learning characteristics that we should know about? (We will elaborate and discuss this via email). *
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/terms-%26-conditions *
Required
Full day: Pick up time & after hours supervision request: Please select the options which best applies to you. (Prices are 'per child'. Please add the corresponding amount to your total payment in the appropriate question below:
Standard pick up 3.15 - 3.30pm (no charge)
3.30 - 3.45pm (+ $10) per child
3.45 - 4pm (+$20) per child
Full day
Clear selection
Half day: Pick up time & after hours supervision request: Please select the options which best applies to you. Prices are 'per child'. Please add the corresponding amount to your total payment in the question below:
Am Pick up: (Standard) - 11.45am - 12pm (no extra charge)
Am Pick up: 12 - 12.15pm (+$10) per child
Am Pick up: 12.15 - 12.30pm (+$20) per child
Pm Pick up: 3.15 - 3.30pm (no charge)
Pm Pick up: 3.30 - 3.45 (+ $10) per child
Pm Pick up: 3.45 - 4pm (+ $20) per child
Half Day
Please summarize what it is you are paying for below: e.g: 1 x child, full day (with early full payment discount) = $57 x 8 weeks = $456 + $10 late pick up each day ($80) = $536 *
Please indicate below your intended payment schedule: *
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 "Full"  or "Half"  followed by your child's last name in the reference.
Clear selection
Submit
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