Out of School Programme Enrolment

Childs Name*
First Last
Boy / Girl*
- Boy
- Girl
Date of Birth*
Date Format: DD slash MM slash YYYY
Address*
Street Address City ZIP / Postal Code
Invoice Email Address*
Mother’s Name: [Title, Christian Name, Surname]*
Home Phone*
Place of Work:
Work Phone
Father’s Name: [Title, Christian Name, Surname]*
Home Phone*
Work Phone
Place of Work:
Alternate Emergency Contact 1*
First Last
Phone
Alternate Emergency Contact 2*
First Last
Phone
Child named above live with:*
- Mother only
- Father only
- Both parents
People authorised to collect my child[ren] from Kids Rock Out of School Programme:
First Last
Phone
People authorised to collect my child[ren] from Kids Rock Out of School Programme:
First Last
Phone
Are there any special circumstances that we should be aware of in relation to your child, e.g. is there anybody you DO NOT wish to collect your child from Kids Rock Out of School Programme?
CHILDREN’S HEALTH
Please write any health conditions that we should be aware of e.g. asthma, allergies, etc.
Any serious illness, injuries or disabilities?
Food Allergies:
Any ongoing medications to be administered?
I hereby give permission for a staff member to give my child any required medication if it is requested in writing by me, or following a phone call.
Name
Family Doctor is:
Phone
Start Date*
Date Format: DD slash MM slash YYYY
Out of School Programmes
Programme*
- Breakfast Club
- After-School
- Holiday Programme
- Casual
OUR REQUIREMENTS FOR KIDS ROCK OUT OF SCHOOL PROGRAMME
- Monday 7.30am – 8.30am
- Monday 3.00pm – 4.00pm
- Monday 3.00pm – 4.30pm
- Monday 3.00pm – 5.00pm
- Monday 3.00pm – 5.30pm
- Tuesday 7.30am – 8.30am
- Tuesday 3.00pm – 4.00pm
- Tuesday 3.00pm – 4.30pm
- Tuesday 3.00pm – 5.00pm
- Tuesday 3.00pm – 5.30pm
- Wednesday 7.30am – 8.30am
- Wednesday 3.00pm – 4.00pm
- Wednesday 3.00pm – 4.30pm
- Wednesday 3.00pm – 5.00pm
- Wednesday 3.00pm – 5.30pm
- Thursday 7.30am – 8.30am
- Thursday 3.00pm – 4.00pm
- Thursday 3.00pm – 4.30pm
- Thursday 3.00pm – 5.00pm
- Thursday 3.00pm – 5.30pm
- Friday 7.30am – 8.30am
- Friday 3.00pm – 4.00pm
- Friday 3.00pm – 4.30pm
- Friday 3.00pm – 5.00pm
- Friday 3.00pm – 5.30pm
Please indicate the days you require your child to attend Kids Rock Out of School Programme by ticking the boxes.
OUR REQUIREMENTS FOR KIDS ROCK OUT OF SCHOOL PROGRAMME
- Monday 7.30am – 5.30pm
- Tuesday 7.30am – 5.30pm
- Wednesday 7.30am – 5.30pm
- Thursday 7.30am – 5.30pm
- Friday 7.30am – 5.30pm
CONDITIONS OF ENROLMENT
CONDITIONS OF ENROLMENT
- I understand that by making a Permanent or Holiday Enrolment/booking I will be charged for that time regardless of whether or not my child attends that day.
- I agree to paying fees no later than 7 days after receiving the invoice/statement
- I understand that the above named child[ren]may be suspended if there is any default in payment.
- I understand that cost recovery of any defaulted payment will be charged to the debtor
- I understand that a Casual Booking will depend upon the number of spaces available on the day and that 24 hours notice is required in order to check the availability of space. [Minimum charge of $8.00 for one hour applies]. Bookings are charged for the whole time that the child/children is/are enrolled for and are not reduced due to early collection from the Programme, e.g.: If the child is booked in from 3:00 to 4:30 but is collected at 3:30 you will still be charged until 4:30.
- I understand I will be charged for that time regardless of whether or not my child attends that day unless 24 hours notice is given to cancel my casual booking.
- I understand that I will not drop my child[ren] at the Tirau Primary School gate. It is my responsibility to escort my child[ren] to the Tirau School Library, and to sign them in the register, unless prior arrangements have been agreed upon with Moe.
- I understand I will pick up my child[ren] from the Tirau Primary School Library at the end of the day and sign them out in the register.
Kids Rock Out of School Programme will provide a happy, safe and learning environment for your child[ren]. We will look to you for support in any disciplinary matters that may arise. Despite offering high standards of supervision, the Kids Rock Out of School Programme staff do not accept responsibility for breaches of behavioural expectations such as leaving the school grounds. The applicant accepts that any behaviour deemed by the Programme Manager to be unreasonable or unsafe may be considered reason for suspension from the Kids Rock Out of School Programme.
Signature [Parent/Caregiver]:*
Date*
Date Format: DD slash MM slash YYYY
DECLARATION
- I understand that the Kids Rock Out of School Programme staff will exercise due care, but will not be liable for any injury, damage or loss which my child[ren] may sustain to their person or property.
- In the event of sickness or accident I authorise qualified medical attention be arranged at my expense.
- I give permission for the Programme staff to administer first aid.
- I have received a copy of the fee structure and the enrolment book and agree to abide by these conditions.
Signature [Parent/Caregiver]:*
Date*
Date Format: DD slash MM slash YYYY

Out of School Programme Enrolment

CHILDREN’S HEALTH

Out of School Programmes

CONDITIONS OF ENROLMENT