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Nature'sCool - Sign Up Form - Term 2, 2020
Please complete this form if you want to sign your child(ren) up for the Nature'sCool Term 2 programme 2020. This programme is six weeks in total beginning Wednesday 127th May and ending Wednesday 1st July. This form is for the Full day or Half day. For full details please visit:
www.safeoutdoors.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 paid / first served basis with Full day participants also taking priority. Part payment plans aligning with the Terms & Conditions (2 weeks in advance) qualify in this regard. Information regarding available spaces can be found below. (Please email
safeoutdoorsnz@gmail.com
if you have any questions).
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* Indicates required question
Email
*
Your email
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?
*
One
two (qualifies for 5% discount)
three (qualifies for 5% discount)
More (Qualifies for a medal + 5% discount)
What is your child / children's full name(s)?
*
Your answer
How old are they?
*
Your answer
Please choose from the following options:
Full day ($45)
Half Day (Am) ($25)
Half day (Pm) ($25)
Wed
Full day ($45)
Half Day (Am) ($25)
Half day (Pm) ($25)
Wed
Clear selection
If your child(ren) attend school, please list the name of the school below:
Your answer
Do you require assistance compiling an application for release of your child from school?
*
Yes please (send a comprehensive description of why this programme will benefit your child to
safeoutdoorsnz@gmail.com
.)
No thanks I got this
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)?
*
Yes i give permission.
No i do not give permission.
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).
*
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?
*
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/terms-%26-conditions
*
Agree
Disagree
Other:
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
Full day
Standard pick up 3.15 - 3.30pm (no charge)
3.30 - 3.45pm (+ $10) 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
Half Day
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
Half Day
Please summarize what it is you are paying for below: e.g: 1 x child, full day for 6 weeks = $270. or 1 x child, full day + $10 late pick up each day ($60) = $330
*
Your answer
Please indicate below your intended payment schedule:
*
Full immediate payment
Fortnightly payments (2 weeks in advance )
Other (please email me with request)
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.
Paid
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