Nature'sCool - Sign Up Form - Term 4,  2020
PLEASE NOTE: At this stage our Term 4 programme is full. However, we are in the processes of figuring out a solution so that we can get more kids involved. If you are keen to get your child involved in the Term 4 programme then please complete this form so that we have all of the formalities out of the way.

The Term 4 programme is ten weeks in total beginning Wednesday 14th October and ending Wednesday 16th December.  For full details please visit: www.safeoutdoors.co.nz/details .

Please note that the maximum number of participants is (14) at any one time and the minimum number is (8), with a ratio of 1:7. Spaces will be issued on a first paid / first served basis. Part payment plans aligning with the Terms & Conditions (2 weeks in advance) qualify in this regard.  (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 ($60)
Wed
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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? *
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
Full day
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Please summarize what it is you are paying for below: e.g: 1 x child, full day for 9 weeks = $540   (- 5% discount for early full payment) = $513 *
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 NC"  followed by your child's last name in the reference.
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