Bay Kids Club

Online Enrolment Form

Child(rens) First and Last Names and Age.

Name

Age

Name

Age

Name

Age

Enrolment details (please put a tick in the box by clicking on it).

Days you would like to enrol your child(ren).

People authorised to collect your child(ren). (Please separate names with a comma).

Parent/caregiver

Name

Address

Phone Number (Day)

Phone Number (After Hours)

Mobile Number

Parent/caregiver 2

Name

Address

Phone Number (Day)

Phone Number (After Hours)

Mobile Number

Emergency Contact 1.

Name

Relationship to Child

Address

Phone Number (Day)

Phone Number (After Hours)

Mobile Number

Emergency Contact 2.

Name

Relationship to Child

Address

Phone Number (Day)

Phone Number (After Hours)

Mobile Number

Doctors Details.

Child(ren)'s Doctor

Doctors Phone Number

Doctors Address

Additional Information

Does your child have any particular health needs we should be aware of? (eg, allergies, food requirements, asthma, medical conditions etc.) Please enter details below.

Is there anything else we should know about in order to take good care of your child? (eg, custody arrangements, special needs, behavioral issues etc.) Please enter details below.

Parent/Authorised Gaurdian Contract

Please read this contract and put a tick in agreement box and click the “Submit” button to complete enrolment. If you have any questions about the programme or wish to see a copy of the programme policies prior to signing, please do not hesitate to ask a member of the staff.

I/we agree and acknowledge.

  • I have read and understand the enrolment information.
  • The supervisor has my permission to arrange any necessary urgent medical treatment at my cost.
  • I will notify the supervisor of any changes to the enrolment information in a timely fashion.
  • I agree to pay fees as stipulated in the fees policy.

All care will be taken to provide supervision of children attending the programme in accordance with programme policies and procedures.

Name of Parent/caregiver

Date

Email address

I have read and agree to the contitions above. Please check the agree box.

Privacy Act 2020: The information that you have supplied is necessary for the safe and effective operation of the OSCAR programme. All personal information requested will be destroyed at the completion of your child’s time with the programme. You are welcome to review information pertaining to your child’s enrolment at any time. Please contact Privacy Officer Eileen for any questions. 021 124 1077 or info@baykidsclub.co.nz

Before and After School Care Titahi Bay, Porirua, Wellington