st andrew's kelly sports enrolment form april 2013
TRANSCRIPT
7/29/2019 St Andrew's Kelly Sports Enrolment Form April 2013
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1
St Andrew’s – Kelly Sports Enrolment form:
(1) Child’s name:
Gender: (please tick) Male Female DOB:
Medical Information:
Medication details (if applicable)
Please indicate days required by marking the relevant boxes.
Mon 29
April
Tues 30
April
Wed 1
May
Thurs 2
May
Fri 3 May Total
Morning
session
0845-1145
$17.00 $17.00 $17.00 $17.00 $17.00
Afternoon
session
1215-1515
$17.00 $17.00 $17.00 $17.00 $17.00
Free Family
bbq 12.00-
1500 (with
games from
Kelly Sports
Full day
0845-1515
$30.00 $30.00 $30.00 $30.00 $30.00
Full week of
full days
$125.00
Full week of
half days
$75.00 (please indicate which days above)
7/29/2019 St Andrew's Kelly Sports Enrolment Form April 2013
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2
(2 ) Child’s name:
Gender: (please tick) Male Female DOB:
Medical Information:
Medication details (if applicable)
Please indicate days required by marking the relevant boxes.
Mon 29
April
Tues 30
April
Wed 1
May
Thurs 2
May
Fri 3 May Total
Morning
session
0845-1145
$17.00 $17.00 $17.00 $17.00 $17.00
Afternoon
session
1215-1515
$17.00 $17.00 $17.00 $17.00 $17.00
Free Family
bbq 12.00-
1500 (with
games from
Kelly Sports
Full day
0845-1515
$30.00 $30.00 $30.00 $30.00 $30.00
Full week of
full days
$125.00
Full week of
half days
$75.00 (please indicate which days above)
7/29/2019 St Andrew's Kelly Sports Enrolment Form April 2013
http://slidepdf.com/reader/full/st-andrews-kelly-sports-enrolment-form-april-2013 3/5
3
(3 ) Child’s name:
Gender: (please tick) Male Female DOB:
Medical Information:
Medication details (if applicable)
Please indicate days required by marking the relevant boxes.
Mon 29
April
Tues 30
April
Wed 1
May
Thurs 2
May
Fri 3 May Total
Morning
session
0845-1145
$17.00 $17.00 $17.00 $17.00 $17.00
Afternoon
session
1215-1515
$17.00 $17.00 $17.00 $17.00 $17.00
Free Family
bbq 12.00-
1500 (with
games from
Kelly Sports
Full day
0845-1515
$30.00 $30.00 $30.00 $30.00 $30.00
Full week of
full days
$125.00
Full week of
half days
$75.00 (please indicate which days above)
7/29/2019 St Andrew's Kelly Sports Enrolment Form April 2013
http://slidepdf.com/reader/full/st-andrews-kelly-sports-enrolment-form-april-2013 4/5
4
Caregiver information:
1st contact person:
Relationship to child/ren
Contact number 1: Contact number 2:
Home address:
Contact email:
Home phone number:
2nd
contact person:
Relationship to child/ren
Contact number 1: Contact number 2:
Home address:
Contact email:
Home phone number:
Alternative pick up persons information: Alternative persons authorised to collect your
child/ren excluding first or second contact persons.
PLEASE NOTE: If you wish for your child to be collected by someone not listed please inform us prior
to pick up.
Alternative person 1
Relationship to child/ren
Alternative person 2
Relationship to child/ren
Please state below whether there are people who are unauthorised to collect your children:
7/29/2019 St Andrew's Kelly Sports Enrolment Form April 2013
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5
Friday 3 May – Family Fun BBQ with games from 12-3pm – Please indicate whether you would
like to come & join us for a Free farewell BBQ with Kelly Sports games & how many will be attending.
Yes we will be attending the bbq No we will not be attending the bbq
Number of attendees:
Any special dietary requirements:
General notes:
The Parish of Pautahanui will be providing the facilities for this awesome Kelly Sports
programme in a safe and secure environment @ the Parish Centre, 11 Steyne Avenue,
Plimmerton. Specialised coaches from Kelly Sports will be running each session. Please be
aware that trips to Plimmerton Domain, the beach, Plimmerton school field and the beach
are incorporated into the programme.
Payment must be received in advance for this programme. Refunds cannot be given without
1 week’s prior notice. Staff and coaches from Kelly Sports need to be booked in advance
and The Parish of Pautahanui will not be liable for any costs incurred by non attendees.
Pick-ups must be prompt @ 11.45 for morning sessions and 15.15 for afternoon sessions. A fee
may be charged for late pickups and staff will not be held responsible for children afterscheduled pick up time.
St. Andrew’s has a facebook page which will be updated with photographs o f the
holiday programme on a daily basis. Please can you indicate below whether you are
willing to have photos on this page:
I am willing / not willing to have my child/ren’s photographs appear on St . Andrew’s facebook
page.
Caregivers name:
Caregivers signature: Date:
Please email to [email protected] or drop in to
St Andrew’s Parish office (or letterbox), 11 Steyne Avenue, Plimmerton.