Big Kids Club School Holiday Fun 2025

Child's Information
Atma Wellbeing presents
Big Kids Club School Holiday Fun 2025
for 9 to 13 year olds

Thursday 18th & Friday 19th December

9.00am to 3.00pm Daily

Venue - Brooklyn Primary School - Hall

Maximum of 12 'Big Kids' per session

Email: info@atmawellbeing.co.nz
Childs First name
Last name
Birthdate
Male or female?

FemaleMale
Parent's Information
Parent's/Guardian's name
Phone number
Email address
Place of work
Street address
Street address line 2
Post code
Please Note: We recommend booking for both days as some activities carry over from the first day to the second day.

THURSDAY 18th DecemberFRIDAY 19th December
Payment is to be made via internet banking to the account below:

$60.00 to attend 1 Day$110.00 to attend 2 consecutive days$95.00 FOR 2 DAYS - EARLY BIRD SPECIAL - Book & Pay BEFORE MONDAY 24th November
BOOK & PAY NOW - Payment required at the time of booking

All equipment, supplies and ingredients included in the price

Please pay directly into the following account: ASB - Jayshree Dayal

12 3021 0197037 02

Reference: Your childs First Name / Surname
Emergency Contact
In the event of an emergency, please contact:
Full name
Phone number
Other people authorised to pick up your child
#1 Full name
#2 Full name
Medical information
Medical Practice and GP
Doctor's phone number
Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns.
In the unlikely event of an injury or illness occuring while your child/ren are participating in our Holiday Programme, the staff of the holiday programme will make every effort to contact you as soon as possible. If we can not reach you, your emergency contact will be contacted. By submitting this form you authorise the staff of the holiday programme to administer such first aid and seek any medical advice they consider necessary (medical expenses to be reimbursed or paid by the parents/guardians).
I give consent for my childs photo to be taken for use on Atma Wellbeing's Social Media & Web Page, in relation to the Big Kids Club School Holiday Programme

YESNO
I hereby acknowledge that I have read and understood the terms and conditions of my child/ren attending the Atma Wellbeing Big Kids Club School Holiday Programme (found on the Big Kids Club facebook page) - https://www.facebook.com/groups/atmawellbeingbigkidsclub or email bkc@atmawellbeing.co.nz for a copy
First Name Last Name Date Signature
Should be Empty: