RC4Kids Registration Form

Takapuna RC4Kids Registration Form

Term 2 July School Holidays Monday 30th June and Tuesday 1st July Takapuna Rugby Football Club: Onewa Domain , Akoranga Drive, Northcote 9:00 am to 2:30 pm, with drop-off from 8:30am and pick up available until 3pm
Child Information*
Emergency Contact Information
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Relationship to Child/ren*
Parent/ Guardian Email*
Please insure this email is correct as we will be contacting you with more information and what to bring.
Alternative Emergency Contact Name*

First NameLast Name
Alternative Emergency Contact Phone Number*
How did you hear of us?*

Rugby clubReturning customerFacebook advertisingFlyerWord of mouthOther

Payment

Two Day Holiday ProgramChoose the correct quantity when registering more than one child. The sibling discount will automatically be applied. If you wish to register your child for just one day, use the code oneday below. Please remember to add a note with what day your child will be attending.

$120.00NZD Quantity
Item subtotal:$0.00NZD

Enter coupon

Total

$0.00NZD

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

If your child is attending for only one day of our two day program, please make a note of which day they will attend below.
Should be Empty:

Takapuna RC4Kids Registration Form

Emergency Contact Information