House Next Door Registration Form 2025

House Next Door Registration Form 2026

To sign up your child(ren) for our programmes, you must complete the form below accurately. For After School Programme, School Holiday Programme, Intermediate Youth Group and High School Youth Group
Child's Full Name

First and middle name(s)Last Name
Preferred Name/Nickname
Birth Date

MonthDayYear
Child's Phone Number
Ethnicity
Gender
Child's Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any medical or dietary restrictions you child has
How did you hear about The House Next Door?

Emergency Contact Information
Please provide the contact information for another trusted adult in case we cannot reach you in an emergency.

It's important that this is different from the main contact information you provided.
Emergency Contact Name

First NameLast Name
Emergency Contact Phone Number
Relationship to Child

Programmes Child/Youth Attends (Please select all relevant programmes)
Is there anything else you would like us to know?
Not required
Permissions
I give permission for my child to walk home unaccompanied (After School and Holiday Programme only)
I confirm that if my Child is not walking home I will arrange them to be collected by myself or a trusted adult
By submitting this form I give permission for my child to be:
- Transported by fully licensed HND workers in registered and warranted vehicles in accordance with the HND Child Protection Policy.
- Photographed and/or filmed during programmes/activities for use on the HND website and in printed material.
If you wish to revoke permission for any of the above please specify:
The information collected is handled in accordance with the Privacy Act 2020 Amendment Act 2025 and applicable New Zealand privacy laws. We collect, store, and use personal information only for authorised purposes and take reasonable steps to protect your privacy and data security. View our full Privacy Policy here: HND Privacy Policy.
Should be Empty:

House Next Door Registration Form 2026