IMPORTANT INSTRUCTIONS ON HOW TO BOOK:

1. Everything with an asterix (*) must be completed or it wont let you submit your booking at the end. If something does not apply to you type or select N/A so you can move to the next question.

2. Please choose either Four Diamonds (funded programme within Kids Domain for Neurodivergent children/children that require extra support - smaller ratio) OR Kids Domain if your child can be part of a 1:10 ratio IF YOU DO NOT HAVE A CLIENT NUMBER FOR FOUR DIAMONDS PLEASE APPLY HERE FOR ONE

3. Choose the centre location you are wanting to book into - the days that are still available will pop up on screen

4. One child per booking. To book another child in, once you have submitted your first booking, choose the option "book another child in" and all your personal details will be already loaded.

5. If you are wanting to apply for a WINZ Subsidy but HAVE NOT been receiving a subsidy in the last 10 weeks, an OSCAR subsidy application form will need to be completed by yourself and signed off and processed at our end. There is a cut off date for new subsidy applications (this is 1 week before school holidays commence). Payment will be required from you before holiday programme can start for your child. This is due to slower processing times at Work and Income at this time of year. Once WINZ have made full payment of your account the difference or full amount will be refunded back to you. However if you can provide a letter/email confirming your WINZ subsidy has been approved before the school holidays start, the hours approved and the subsidy rate you qualify for then this will not need to be paid before care commences.

6. For changes to your bookings or cancellations (first check the cancellation cut off date below - any cancellations from this date is still payable), you will need to complete the change of booking and cancellation form on our website https://www.kidsdomain.biz/change-of-bookings-notice-form/

7. Read the terms and conditions carefully before agreeing and signing.

8. Trips/outing/Venues may change without notice under the Covid-19 Protection Framework. If we do not go on a trip the trip fee will be refunded.

9. Due to the rising cost of activities, venues, chartered buses etc our funding we receive no longer fully covers the full cost of this to you. There is an extra charge to cover these trips (some trips are partially subsidised)

10. Clear your cache and/or internet browser history before you start this form to avoid any issues

APRIL 2023 SCHOOL HOLIDAY PROGRAMME

PLEASE CHOOSE ONE*

FOUR DIAMONDSKIDS DOMAIN

Kids Domain Fees and Important Dates

Four Diamonds Fees and Important Dates

FOUR DIAMONDS CLIENT NUMBER:*

IF YOU DO NOT HAVE A CLIENT NUMBER YOU WILL NEED TO APPLY FOR ONE (details at top of this form)

Choose a Centre to be Enrolled*

Please select the days/types of session you require below (if on a desktop computer hold the CTRL button down and click on the days you require - these will highlight in blue) SV*

Please select the days/types of session you require below (if on a desktop, hold the ctrl button down and click on the days you require - these will highlight in blue) LH*

Child*

First NameLast Name

Child Address*

sex of child*

femalemale

Age of child*

Ethnicity Group your child most identifies with (this is collected for statistics purposes)*

CONFIRMATION OF YOUR BOOKING/INVOICE TO BE EMAILED TO:*

Confirmation Emailexample@example.com

CHILDS HEALTH/MEDICAL (please select all that apply to your child)*

PLEASE READ!!!

If your child can participate in a 1:10 ratio, please continue with this form. If your child requires extra support, all bookings must have a client number through Four Diamonds Charitable Trust. If you do not have a client number please click here to fill in the assessment form

Medical Condition: please specify details here (example: what the medical condition is eg has asthma - inhaler in school bag)*

Allergies: please specify details here (example: allergic to bee stings)*

ADHD: please specify any details about your child that supervisors need to be made aware of*

ADHD: Does a supervisor need to administer your child's medication?*

YesNo

ADHD: Name of medication required to be administered*

ADHD: Dosage of medication required*

ADHD: Time of day medication is required*

FASD: please specify any details about your child that supervisors need to be made aware of *

ASD: please specify any details about your child that supervisors need to be made aware of *

ODD: please specify any details about your child that supervisors need to be made aware of *

GAD: please specify any details about your child that supervisors need to be made aware of *

GDA: please specify any details about your child that supervisors need to be made aware of *

OTHER DETAILS/REQUIREMENTS*

CUSTODY - Oranga Tamariki, Dept of Courts etcRELIGIOUS - Social, Cultural or ethnic requirementsLEAVING PROGRAMME - Permission to walk home/parents workplace at the end of programme/my child will walk to the centre and be at the programme by 9am etcN/A

Custody: please specify details here (example: in the care of Oranga Tamariki)*

Religious, Social, Ethnic Requirements: please specify details here (example: does not eat pork etc)*

Leaving Programme: please specify details here (example: I give permission for my child to leave the programme at 3.30pm)*

Mother/Caregiver Details*

First NameLast Name

Mother/Caregiver Home Address*

Mother/Carergiver Home Phone*

Mother/Caregiver Mobile Phone*

Mother/Caregiver Work Phone*

Please choose one*

I am workingI am studyingI am working and studyingI DO NOT work or study

Company/Employer*

Work Email Address

Confirmation Emailexample: mary@xtra.co.nz

Name of Institution where you are studying*

Father/Caregiver Details*

First NameLast Name

Father/Caregiver Home Address*

Father/Caregiver Home Phone*

Father/Caregiver Mobile Phone*

Father/Caregiver Work Phone*

Please choose one*

I am workingI am studyingI am working and studyingI DO NOT work or study

Company/Employer*

Work Email Address

Confirmation Emailexample: john@xtra.co.nz

Name of Institution where you are studying*

1st Emergency Contact Full Name*

Relationship to Child*

Best Contact Phone Number(s)*

2nd Emergency Contact Full Name*

Relationship to Child*

Best Contact Phone Number(s)*

PERSON(S) AUTHORISED TO COLLECT YOUR CHILD OTHER THAN YOURSELF (Your child will not be allowed to leave if Kids Domain has not been notified prior to pickup of somebody not listed) *

WHO IS PAYING FOR YOUR CHILDCARE?

DOES YOUR CHILD RECEIVE*

Child Disability Allowance (CDA)Carer SupportIndividualised FundingN/A

WHEN WAS THE LAST TIME YOU RECEIVED A CHILDCARE OSCAR SUBSIDY?*

I have never applied beforeI have not received an OSCAR subsidy for over 10 weeksI get an OSCAR subsidy for Before/After School Care currentlyI got a subsidy last school holiday programme

PAYMENT TERMS*

COST: All prices are advertised on our website when booking. Due to price increases, trips/outings will incur an extra charge which is noted on the activity schedule . An Invoice will be emailed to you to pay on.
CANCELLATIONS/CHANGES TO BOOKINGS/CREDITS/REFUNDS: refunds and credits will only be given if cancellation is received before the cut off date advertised on our website. (you will be required to fill in the form change of booking/written notice form which is available on our website https://kidsdomain.biz/change-of-bookings-notice-form/ Texts, emails or verbal notice is not accepted. A copy is automatically emailed to you for your records once you have completed this form and this will be date stamped by Kids Domain and held with your booking. An administration fee of $5 per day per child will apply to cover administration costs (this includes any changes to your booking days). Activities are prepaid in advance and as we roster our amazing staff to have the correct ratios, no refunds/credits will be approved if the correct notice is not received and/or you want to cancel after the cancellation cut off date (date advised on the website and on this form). Children that have 1:1 supervision arranged is still payable once invoice has been issued. Refunds/Credits are not available from invoice date.
ACCOUNT DETAILS: Kids Domain, ANZ Bank, 06 0545 0282917 00 - please use your child's first/last name as reference/particulars or Four Diamonds, ANZ Bank, 06-0773-0866623-00 – please use invoice number or child’s first/last name. Cheques will not be accepted. All invoices/statements are emailed. If you require these to be printed and/or posted there will be a fee of $1.50 each time. Accounts that are not paid on time will incur a $5.00 late payment fee each week outstanding until the account is zero balance. Unpaid fees will be placed with a debt collection agency and/or department of courts where parents/caregivers will be liable for collection & court fees incurred.
PAYMENT PLAN: Regular weekly payments must be made and the full balance to be paid in full by the end of this holiday programme. Your payment schedule will be on the invoice. Accounts in arrears at the end of the school holidays will incur late payment fees
PAYMENT WITHIN 2 WORKING DAYS - Full payment is due within 2 working days of invoice. Accounts not paid in full within this timeframe will not receive the discount. Accounts in arrears at the end of the school holidays will incur late payment fees
WINZ APPLICATIONS NEED TO BE RECEIVED BY KIDS DOMAIN WITHIN 2 WORKING DAYS OF YOUR BOOKING.
All WINZ subsidy applications need to be processed and scanned in by Kids Domain WINZ administrator, hard copies will be sent off to the Childcare Unit once this has been done.
If we do not receive your WINZ form within 2 working days of this booking your child's placement will AUTOMATICALLY CANCEL and you will be required to rebook (subject to placements being available).
WINZ subsidy forms are available to download from our website www.kidsdomain.biz (go to WINZ subsidy page), hard copies are also available at each centre (best time to collect a form is between 3.30pm and 5.00pm Monday to Friday)
We accept applications scanned/emailed directly to us to make things easier for you email: kidsdomain@slingshot.co.nz - please make sure you have fully completed your form and attached latest payslip if working (a photo of payslip is fine as long as it is clear to read) WINZ will decline your subsidy if payslip has not been provided. If you are unable to get a payslip within 2 working days, please let us know so this does not hold up processing the application as we can forward this straight onto the childcare unit later. Please note that processing of your subsidy is between 2-4 weeks delay so please make sure you have completed your forms correctly and provided all documentation required to avoid any hold ups.
Please note: for families that are not currently receiving a subsidy (new subsidy applications) and families that do not have an account with us are required to pay 50% deposit upfront or weekly payments to cover your fee (which is refundable once WINZ have made full payment) However if you can provide a letter/email confirming your subsidy has been approved, hours approved and the subsidy rate you qualify for then this will not need to be paid.
If your subsidy is declined, the deposit will come off the total balance owing. However if you can provide a letter/email from WINZ confirming your subsidy approval, the hours they are paying and the subsidy rate you qualify for then this will not need to be paid. This must be received by Kids Domain before the school holidays commence.
Families that have a balance to pay will be required to pay this off weekly with final payment by the end of the holidays or in advance. Kids Domain will not accept payment plan once the holidays have finished.
EARLY DROP OFFS
If you require an early drop off, this needs to be arranged prior with management at LEAST 24 hours IN ADVANCE so we can make sure Kids Domain has the correct staff ratio. Please complete the change of booking form on the school holiday programme page to do this. Under no circumstances can you drop your child off before 8.30am as this becomes a health and safety issue. You will be contacted by a staff member to return.
LATE PICKUPS
If you have booked the half day session, pickups from 3.30pm onwards will incur a late pickup fee of $20 for the first 15 minutes (3.30pm-3.45pm) and $20 per 5 minutes after that. Pickups from 5.30pm onwards will incur a late pickup fee of $20 for the first 15minutes (5.30pm to 5.45pm) and $20 per 5minutes after that. This fee will be applied to your account to cover the cost of staff having to work overtime. Invoices must be paid within 2 working days of invoice date.
OTHER INFORMATION: Parents/caregivers are to see a supervisor on arrival so they can sign your child in on the Ipad, upon pickup please see the supervisor so they can sign your child out on the Ipad. Please ensure all medication is given to a supervisor so they can administer and record on their file. All medication in pill form has been given in the correct dosage for that day. We cannot cut tablets in half, quarters (this has to be done by the parent/caregiver) for health and safety reasons. Please bring everyday - morning tea, lunch, afternoon tea, snacks and water bottle. We are not able to do cookups of noodles, heat left over dinner etc. so please bring a packed lunch. During summer sunhats and sunblock are required everyday. We also request you to sunblock your child prior to attending in the mornings and name their sunblock and keep in school bag. Outdoor pools/beach trips we highly recommend your child wear a rashvest/t-shirts/hats to protect them from the harsh rays (even on overcast days). Days activities may change unexpectedly so please ensure your child has appropriate clothing - e.g jackets, warm/cool clothing. Skirts/good clothing may not be appropriate. Photos/video/artwork may be used in a range of promotional materials, such as print and electronic media, including our websites and social media pages. New enrolments will be automatically added to our mailing list
BUS TIMETABLE: Is included with the activity schedule for all the outing (trip days) and will be put up at each centre also - the bus is unable to wait if you are late so please make sure your child/ren arrive at the centre at least 15 minutes before the bus is due to depart.
SICKNESS: Please keep your child at home if they are unwell until recovered as we do not have the facility to look after sick children. If your child attending the programme becomes unwell we will contact you to collect your child as soon as possible. Please notify the centre if your child has been diagnosed with an infectious illness straight away. If your child has had vomiting or diarrhoea either at the centre or at home they will be excluded from the programme until they have been symptom free for 24hours.
BEHAVIOUR MANAGEMENT: You may be contacted to collect your child at the supervisors discretion and you will be liable for any costs if your child damages property. The fee is non refundable if your child has been removed from the programme
CHILDRENS PROPERTY: children are welcome to bring in toys, cellphones, tablets etc, but it is their responsibility. Staff will not be able to look after the children’s property so this must be kept in their school bags.
Kids Domain and staff will be free and clear of all liability in the event of any injury as accidents do happen from time to time, damage or loss sustained by your child or to personal affects. A full copy of policies and procedures are available to read at each centre or online www.kidsdomain.biz/policies. Photos/video/artwork may be used in a range of promotional materials, such as print and electronic media, including our websites/facebook page. I have read, understood and agree to Kids Domains policies and procedures, the above terms, the booking information I have given is correct and this booking forms a legally binding contract between myself and Kids Domain. Kids Domain's privacy policy is governed by the New Zealand Privacy Act 2020. If you voluntarily provide personal information (eg, through email feedback or online forms), we will keep that personal information secure and will not disclose it to any third party. Any personal information supplied will only be used for the purpose for which it was provided or permitted by the Privacy Act 2020 or otherwise required by law. Any information gathered may be viewed by the Ministry of Social Development for audit purposes, in line with the Privacy Act 2020, personal information required to be utilised that relate to any unpaid fees, can be passed to a debt collection agency and/or department of courts.

YES, I HAVE READ, UNDERSTOOD & AGREE TO THE TERMS AND CONDITIONS*

Yes

Full Name*

First NameLast Name

How did you hear about us?*

Documents you would like to attach (includes winz forms, medical information, behaviour plan etc)

Upload Documents Here

Date Signed*

HourMinutesAM/PM Option

Please check your form carefully before pressing the 'submit form now' button below as booking will confirm automatically and the fee is payable

Kids Domain Fees and Important Dates

Four Diamonds Fees and Important Dates

In the event of an emergency and we are unable to get hold of the parent/caregiver, it is very important we have emergency contact people (this could be friends, family, neighbours etc). Please list below: