Holiday Programme April 2023 Registration Forms

PACT Holiday Programme runs during the first week of every school holidays and before the school year begins in the summer holidays for children aged 7-13

Programme is held in the PACT building, 311 Great South Road, Papatoetoe

Programme runs from 8:45am—3pm (additional hours available on request)

$20 per non trip day and $30 per trip day for each child. This would be a total of $100 for the four days.

WINZ OSCAR Subsidy available

Phone: 0210422545

Email: larissa@pact.org.nz

Parent / Caregiver Contract:

I / we agree and acknowledge:

I have read and understand the Information for Parents / Caregivers. The PACT Holiday Programme has been approved under the MSD OSCAR Standards.
All care will be taken to provide a safe and well-supervised
environment for children attending the programme, in accordance with our Holiday Programme policies and procedures.
The PACT Holiday Programme Policies and Procedures can be viewed here.
The Holiday Programme Co-ordinator has my permission to arrange urgent medical treatment, at my cost, and to move my child by private motor vehicle or by ambulance, if necessary.
I will notify the Holiday Programme Co-ordinator of any changes to enrolment information in a timely way.
I understand that PACT is a Christian organisation and that there will be Christian devotions, prayers and open discussions about Christian faith during the Holiday Programme.
I agree to pay fees as stipulated in the fees policy.
I give permission for my child to take part in the trips over the week and to be transported to and from these trips. *A timetable with the specific trips will be made available on the first day of the programme. Please let us know if you have any concerns.
I understand that the programme management reserves the right to exclude from the programme any child who is frequently disruptive, ignoring programme rules, or who poses a significant risk to the safety of themselves or others. The programme strives to be fair, positive and consistent in helping children behave appropriately.
I understand that if my child is sick or doesn't attend Holiday Programme after I've made the booking that the fees are still payable.
I understand that if a Holiday Programme staff member witnesses or suspects neglect or abuse of any young person, they are required to inform the appropriate authorities.

Please tick if you DO NOT want your child photographed. Photos may be used on our website, Facebook page, Instagram or other PACT publications.

We would like to include your email address in our PACT database so that we can send you our newsletter and other information from time to time. Please indicate below if you give permission for your name and email address to be added.

Yes I give permission

Please sign this contract to complete enrolment form.

Clear

Privacy Act 2020: The information that you have supplied is necessary for the safe and effective operation of the holiday programme, and has only been collected for that purpose.
You may review information pertaining to your child’s enrolment at any time.

Fees: The cost is $100 per child for 4 days. Once we receive your completed enrolment form we will send you an invoice for the fees which must be paid by 31 March 2023 to confirm their place in the pgoramme.

Assistance with fees is available so please let us know if you require a discount.

WINZ subsidies are aalso vailable, but please let us know first if you intend to apply.

Internet banking: 12-3044-0377903-09 ref: child’s name

Cancellations: No refunds of fees will be given after 31 March 2023 unless we can fill your child's space.

Day register: Parents/caregivers are required to sign their children in and out of the programme. Children may be signed in no earlier than 8.45am, and must be picked up no later than 3.15pm.

Additional hours: You are able to sign your child up from 8am-5pm, an extra $5 per extra hour (outside of 9am-3pm) will be charged per child.

Written notification: Written notification is required if someone other than the parent/caregiver is collecting your child/ren. No child is to leave the programme unaccompanied without permission from the parent/caregiver and prior agreement by the Holiday Programme Co-ordinator.

Emergency contacts: Please provide at least 1, preferably 2, emergency contacts who are not a parent.

Sick children: Please contact Larissa and leave a message (before 9.30am) if your child is unable to attend the programme for that day. Children who are unwell should not attend the programme. If your child becomes unwell or is injured while on the programme, parents/caregivers or emergency contacts will be notified.

Appropriate clothing: Appropriate clothing should be worn, as we cannot be responsible for spoiled or lost property. Please name children's belongings. We will endeavour to return named lost property.

Morning tea is provided each day except on the day of the Parakai Hot Pools trip. Please note that your child will need to bring a bag with a packed lunch each day.

Any queries please contact the Holiday Programme Co-Ordinater, Larissa O'Gorman on larissa@pact.or.nz

How many children are you enrolling?*

One childTwo childrenThree childrenFour children

Please indicate the days/sessions that you are enrolling them for (please note some children may go on the trip on the Thursday so if you want your child/ren to go on a particular day please let us know)*

Tuesday 11 April 8.45am - 3.00pm $20Tuesday 11 April 3.00pm - 5.00pm $5.00 (extended hours)Wednesday 12 April 8.45am - 3.00pm $30 (trip day)Wednesday 12 April 3.00pm - 5.00pm $5.00(extended hours)Thursday 13 April 8.45am - 3.00pm $20Thursday 13 April 3.00pm - 5.00pm $5.00 (extended hours)Friday 14 April 8.45am - 3.00pm $30 (Parakai trip day)Friday 14 April 3.00pm - 5.00pm $5.00 (extended hours)

Child(ren)'s Details

Child 1*

First NameLast Name

EthnicityDate of Birth

Child 2

First NameLast Name

EthnicityDate of Birth

Child 3

First NameLast Name

EthnicityDate of Birth

Child 4

First NameLast Name

EthnicityDate of Birth

People authorized to collect your children

Mother/caregiver one details*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Mobile number*

Area CodePhone Number

Father/caregivers two details

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.

Emergency contact details*

First NameLast Name

Relationship to child*

Mobile Number*

Area CodePhone Number

Emergency contact details (second person)

First NameLast Name

Relationship to child

Phone Number

Area CodePhone Number

Additional Information

Does your child have any particular health needs we should be aware of? Eg, allergies, food requirements, asthma, medical conditions etc. Please list any medications taken or required:*

Is there anything else we should know about in order to take good care of your child? Eg, custody arrangements, special needs (including cultural), behavioural needs etc.

PACT Holiday Programme Enrolment Form

Parent / Caregiver Information

Enrolment Form