Christchurch - Alternate Education Day Registration Form
Parent / Carer Name
*
Parent / Carer Email Address
example@example.com
Parent / Carer Contact Phone Number
*
Parent / Carer Address
*
Have you registered before?
*
Please Select
Yes
No
Name of Child
*
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Childs Date of Birth
*
-
Day
-
Month
Year
Date
1st Emergency Contact Name
*
1st Emergency Contact Phone Number
*
1st Emergency Contact Relationship to Child
*
Has your child had a formal diagnosis? If Yes, please provide more info.
What special interests does the child have?
Describe your child's communication capability, i.e. non verbal, verbal with limited vocabulary, good communication
*
Any known triggers to be aware of?
Toileting capability
*
No assistance needed
Assistance needed
Other
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Does your child have any allergies? Please list all allergies and type of reaction
Does your child need to take any medication during the day? If yes, provide additional details.
Are you comfortable with your child eating in a shared food situation?
*
Yes
No
Other
Are you comfortable with your child's picture being shared on social media (with face covered)?
*
Yes
No
Other
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Please check each day you would like your child to attend for term 2 2026
Wednesday 27 May
Wednesday 3 June
Wednesday 10 June
Wednesday 17 June
Wednesday 24 June
Wednesday 1 July
Payment terms (invoicing will be per term)
*
By Invoicing (including IF)
Carer Support (please contact emma@positivepathways.nz)
Submit
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