Dec 2023/Jan 2024 Mt Cook (New) Holiday Programme

Student's Full Name:*

First NameLast Name

MaleFemale

Student's Birthday*

Date

Student's School:*

Parent / Caregiver Full Name:*

First NameLast Name

Parent / Caregiver Phone Number*

Area CodePhone Number

Parent / Caregiver Email Address*

example@example.com

The following adult is authorised to pick up my child:*

First NameLast Name

Please select the programmes you wish to enrol in:*

Monday 18th Dec, 2023 Not Available

$ FreeNZD

Tales of the Tombs - Tuesday 19th Dec, 2023

Tuesday, 19th Dec 2023 (9:00am - 4:00pm)

$79.00NZD Quantity

Technological Time Warp - Wednesday 20th Dec, 2023

Wednesday, 20th Dec 2023 (9:00am - 4:00pm)

$69.00NZD

Extra-terrestrial Odyssey - Thursday 21st Dec, 2023

Thursday, 21st Dec 2023 (9:00am - 4:00pm)

$69.00NZD

Santa's Spectacular - Friday 22nd Dec , 2023

Friday, 22nd Dec 2023 (9:00am - 4:00pm)

$69.00NZD

Monday 15th Jan, 2024 Not Available

$ FreeNZD

Comic Crusaders - Tuesday 16th Jan, 2024

Tuesday, 16th Jan 2024 (9:00am - 4:00pm)

$69.00NZD

Teenage Turtle Takeover - Wednesday 17th Jan, 2024

Wednesday, 17th Jan 2024 (9:00am - 4:00pm)

$69.00NZD

Guardians and Galaxies - Thursday 18th Jan, 2024

Thursday, 18th Jan 2024 (9:00am - 4:00pm)

$69.00NZD

X-Men Unleashed - Friday 19th Jan, 2024

Friday, 19th Jan 2024 (9:00am - 4:00pm)

$69.00NZD

Monday 22nd January 2024 - Public Holiday

$ FreeNZD

Fun Fair Fiesta - Tuesday 23rd Jan, 2024

Tuesday, 23rd January 2024 (9:00am - 4:00pm)

$69.00NZD

Summer Showdown - Wednesday 24th Jan, 2024

Wednesday, 24th January 2024 (9:00am - 4:00pm)

$69.00NZD

Island Escape - Thursday 25th Jan, 2024

Thursday, 25th January 2024 (9:00am - 4:00pm)

$69.00NZD

Cirque du Soleil - Friday 26th Jan, 2024

Friday, 26th Jan 2024 (9:00am - 4:00pm)

$69.00NZD

Total

$0.00NZD

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

Name

First NameLast Name

Date

Name

First NameLast Name

Phone Number

Area CodePhone Number

Email

example@example.com

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.

YesNo

Mt Cook Dec 2023 & Jan 2024