Nature'sCool - Summer holiday sign up form. 19 / 20

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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: https://forms.gle/xs3KRc3jTmuha3v3A
Note - If you would like to book additional days in the future, just email safeoutdoorsnz@gmail.com 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 *

Parent name *

Parents contact phone number *

Alternative Emergency contact number (different than above) *

How many children are you signing up? *

One

two

three

four

five

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 Early Jan? (you can tick more than one)

Mon 6th Jan

Tues 7th Jan (sorry full)

Thurs 9th Jan (almost full)

Fri 10th Jan

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

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

Jan

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)? *

Yes i give permission.

No i do not give permission.

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? *

That's fine

No thanks

I'm ok with it as long as you let me know where and when so i can make a decision.

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/naturescool-holiday *

Agree

Disagree

Other:

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 (+ $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) *

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. *

Paid

I would like to request a reservation by emailing "safeoutdoorsnz@gmail.com" with details of when this will be paid

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