*Childs Name: *Age:
Childs Name: Age:
Address:
Phone (Home): (Work): (Mobile):
*Parents E-mail Address:
Parents/Caregiver Name:
Emergency Contact Name:
Emergency Contact Number:
Medical Contact: Phone:
School your child attends:
Which programme would you like your child/children to attend: Waimarino (Adventure Club) Supervised Park Days Only
Pick-up/ Drop-off location: Waimarino Bay Park Maungatapu School
Name anyone else that has permission to pick your child up from Waimarino:
Special Needs/Medical Conditions/Custody Arrangements:
How did you hear about us? :
Parent/Guardian Agreement: I give consent for my child/children to participate in the Waimarino Holiday Programme. I understand that there may only be one adult in a vehicle at any one time with no less than two children aboard. Should my child need any medical attention due to sickness or accident I give my permission for Waimarino staff to seek the required qualified medical attention on my behalf. I understand that there will be safety rules, boundaries and regulations that will need to be followed and understand that if my child is not adhering to these rules they may be suspended from the programme. If my child suffers from any medical condition or requires medication I will notify the Waimarino immediately and complete a medical consent form. I understand that the Waimarino has the right to alter or change any of the activities in this program. I confirm that i have read, understood and approve this application and the parent information available on this website.
*I agree to the above terms and conditions: