KIDS DOMAIN
BOOK A VISIT
Full Name
*
First Name
Last Name
E-mail
*
Confirmation Email
example@example.com
Phone Number
*
-
Area Code
Phone Number
Prefered method of contact?
*
Email
Phone
Either
Centre of Interest
*
Stokes Valley
Lower Hutt
Child Name
*
First Name
Last Name
School your child is/will be attending
*
Type of care you are interested in
*
Before School Care
After School Care
Holiday Care
Will you be needing to use our transport service to/from school?
*
Yes
No
Which days would you need to use the transport service?
*
Monday (morning)
Monday (afternoon)
Tuesday (morning)
Tuesday (afternoon)
Wednesday (morning)
Wednesday (afternoon)
Thursday (morning)
Thursday (afternoon)
Friday (morning)
Friday (afternoon)
Is the appointment you would like to book during the school term or school holidays?
*
School Term
School Holidays
I would like to book my visit on (Please allow at least 1-2 working days to confirm your booking)
*
-
Day
-
Month
Year
Appointment's During School Term (please choose which suits you)
*
3.30pm
4.00pm
4.30pm
5.00pm
5.30pm
Appointment's During School Holidays (please choose which suits you)
*
8.00am
8.30am
9.00am
3.30pm
4.00pm
4.30pm
5.00pm
Other details you may wish to highlight
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