Child's Details
Child's Name
*
First Name
Middle Name
Last Name
Date of Birth
*
/
Day
/
Month
Year
Gender
*
Please Select
Male
Female
Ethnicity
*
Iwi (if Māori)
Parent / Caregiver Details
Parent Name #1
*
First Name
Last Name
Parent Address #1
*
Street Address and Suburb
Street Address Line 2
City
State / Province
Postal Code
Email Address #1
*
Mobile Phone #1
*
Alternative Contact Numbers #1
Home Phone
Work Phone
Parent Name #2
First Name
Last Name
Parent Address #2 (if different from above)
Street Address and Suburb
Street Address Line 2
City
State / Province
Postal Code
Email Address #2
Mobile Phone #2
Alternative Contact Numbers #2
Home Phone
Work Phone
Booking Details
Note: Bookings made on this page are indicative only and will be confirmed on enrolment. Minimum booking of two days per week.
Preferred Days
*
Monday
Tuesday
Wednesday
Thursday
Friday
Preferred Start Date
*
/
Day
/
Month
Year
Preferred Location
*
Please Select
Riverview
Maryhill
Happy Either Way
Booking comments / enquiries
Pre-Enrol
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