Term 4 2023 - Northland School

Junior Robotics Level 1 & Level 2

Northland School

Term 4 2023

20th October 2023 – 8th December 2023

Friday 3:15 - 4:45 pm

Child's Details

Student's Full Name:*

First NameLast Name

Student's Gender:*

MaleFemale

Student's Birthday*

Date

Parent / Caregiver Full Name:*

First NameLast Name

Parent / Caregiver Phone Number*

Parent / Caregiver Email Address*

example@example.com

Second Emergency Contact Person Name *

First NameLast Name

Second Emergency Contact Person Phone :

Please enter a valid phone number.

Whole Term Booking*

Friday - Junior Robotics Level 1 (Year 0-3) 3:15-4:45pm ( 90 minutes ) - Whole Term - 8 WeeksFriday 20th October - 8th December 2023

$280.00NZD

Friday - Junior Robotics Level 2 (Year 4-6) 3:15-4:45pm ( 90 minutes ) - Whole Term - 8 Weeks Friday 20th October - 8th December 2023

$280.00NZD

Total

$0.00NZD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Special Instructions

I agree not to send my child to a Bricks 4 Kidz Holiday Programme if presenting with cold or influenza-like symptoms.

I agree to my child receiving minor medical treatment, as considered necessary by first-aid certified staff. Furthermore, I agree to staff seeking further medical attention in the event of an emergency and I consent to treatment by medical authorities present.

I consent for use of any photographs or video recordings that are taken of my child while participating in our programs*

YesNo