» Enrolment Form

PLEASE NOTE 

    Summer Programme dates Monday 15th January to Friday 2nd February   

- payment must be made at time of enrolment. Online enrolments close at 4 pm on Friday 12th January.  You will still be able to enrol your children in the programme by coming in to the Centre after this date.


Parents wanting to attend trips and extra child enrolments can be added at the bottom of the enrolment form


- please read important parent information before your child attends the programme
- if your child is going on a trip or an activity that is not held at the Community Centre there may be important things they need to bring with them.  Please check the Information Sheets for Trips and Activities.


We welcome parents/caregivers to join their child  on the trips please enrol at the bottom of the enrolment form.

Parents and caregivers are more than welcome to stay and join in the fun with their child with the cooking and craft activities please let staff know if you will be joining us.

Please Note: All adult helpers (aged 17 and over) must complete a police vetting form and email it to admin@katikaticommunity.nz or drop it off to the Katikati Community Centre before going on School Holiday Programme trips.

Child's Name *
Child's Gender *
 Male
 Female
Child's Date of Birth *
Child's Age
Address *
Phone (home) *
Phone (work)
Phone (cell)
Email *
Ethnicity
Emergency Contact Name *
Emergency Contact Number *
IMPORTANT! Please provide names of people who will collect your child. E.g.LYNNE (Mum), walk home *
Doctors Name/Clinic
Swimming Ability *
Medical Condition/Special Needs/Custody *
Please outline condition or requirements.
Are you happy to have your child/children photographed for media/promotional purposes? *
Permission: I hereby give permission for my child to take part in the School Holiday Programme which is being organised and supervised by the Katikati Community Centre or their agents. I acknowledge that the Katikati Community Centre or their agents will take all care of my child but will not be held liable for any injury to him/her during the activity. Privacy Act 1993: The Katikati Community Centre wishes to collect the written details for registration purposes, this information will be accessible to Community Centre Staff only (For auditing purposes information gathered may be viewed by Ministry of Social Development. *
 I agree
WEEK 1 Monday 15th January
 Mon 8.30am - 3.30pm $24
Tuesday 16th January
 Tues 8.30am - 3.30pm $24
Wednesday 17th January Trip
 Wed 8.30am - 3.30pm Matakana Island Cruise $28
Thursday 18th January
 Thurs 8.30am - 3.30pm $24
Friday 19th January
 Fri 8.30am - 3.30pm $24
WEEK 2 Monday 22nd January
 Mon 8.30am - 3.30pm $24
Tuesday 23rd January
 Tues 8.30am - 3.30pm $24
Wednesday 24th January Trip
 Wed 8.30am - 3.30pm Slam Jump Inflatable World $28
Thursday 25th January
 Thurs 8.30am - 3.30pm $24
Friday 26th January Trip
 Fri 8.30am - 3.30pm Funky Fun Day at ASB Tect Arena $26
WEEK 3 Tuesday 30th January
 Tues 8.30am - 3.30pm $24
Wednesday 31st January
 Wed 8.30am - 3.30pm $24
Thursday 1st February
 Thurs 8.30am - 3.30pm $24
Friday 2nd February
 Fri 8.30am - 3.30pm $24
PARENTS NAME if coming on a trip (All adults 18 years and over must be police vetted)
Please tick the trip you you will join your child on
 Wed 17th Jan Matakana Island Trip $30
 Wed 24th Jan Inflatable World $5
 Fri 26th Jan Funky Fun Day at ASB Arena $5
2ND CHILD: Name
2nd Child: Gender
 Male
 Female
2nd Child: Date of Birth
2nd Child: Age
2nd Child: Swimming Ability
2nd Child: Medical or other information we need to know
WEEK 1 Monday 15th January
 Mon 8.30am - 3.30pm $19
Tuesday 16th January
 Tues 8.30am - 3.30pm $19
Wednesday 17th January Trip
 Wed 8.30am - 3.30pm Matakana Island Cruise $23
Thursday 18th January
 Thurs 8.30am - 3.30pm $19
Friday 19th January
 Fri 8.30am - 3.30pm $19
WEEK 2 Monday 22nd January
 Mon 8.30am - 3.30pm $19
Tuesday 23rd January
 Tues 8.30am - 3.30pm $19
Wednesday 24th January Trip
 Wed 8.30am - 3.30pm Slam Jump Inflatable World Trip $23
Thursday 25th January
 Thurs 8.30am - 3.30pm $19
Friday 26th January Trip
 Fri 8.30am - 3.30pm Funky Fun Day ASB Arena $21
WEEK 3 Tuesday 30th January
 Tues 8.30am - 3.30pm $19
Wednesday 31st January
 Wed 8.30am - 3.30pm $19
Thursday 1st February
 Thurs 8.30am - 3.30pm $19
Friday 2nd February
 Fri 8.30am - 3.30pm $19
3RD CHILD: Name
3rd Child: Gender
3rd child: Date of Birth
3rd Child: Age
3rd Childs Swimming Ability
3rd Child: Medical or other information we need to know
WEEK 1 Monday 15th January
 Mon 8.30am - 3.30pm $19
Tuesday 16th January
 Tues 8.30am - 3.30pm $19
Wednesday 17th January Trip
 Wed 8.30am - 3.30pm Matakana Island Trip $23
Thursday 18th January
 Thurs 8.30am - 3.30pm $19
Friday 19th Janaury
 Fri 8.30am - 3.30pm $19
WEEK 2 Monday 22nd January
 Mon 8.30am - 3.30pm $19
Tuesday 23rd January
 Tues 8.30am - 3.30pm $19
Wednesday 24th January Trip
 Wed 8.30am - 3.30pm Slam Jump Inflatable World $23
Thursday 25th January
 Thurs 8.30am - 3.30pm $19
Friday 26th January Trip
 Fri 8.30am - 3.30pm Funky Fun Day ASB Arena $21
Tuesday 30th January
 Tues 8.30am - 3.30pm $19
Wednesday 31st January
 Wed 8.30am - 3.30pm $19
Thursday 1st February
 Thurs 8.30am - 3.30pm $19
Friday 2nd February
 Fri 8.30am - 3.30pm $19
Please type the letters and numbers shown in the image.
 
Captcha Code

Click the image to see another captcha.