October 2026 Registration Form

PACT Holiday Programme runs for one week of every school holidays and before the school year begins in the summer holidays for children aged 5-13.

The programme is held in the PACT building, 311 Great South Road, Papatoetoe.

The programme runs from 8:45am–3pm (additional hours available on request).

There is a cost of $20 per non trip day and $35 per trip and special activity for each child.

You can enrol your children for whichever days you choose.

Wednesday 7 October 2026 is the Zoo trip.

Friday 9 October 2026 is the Kaipātiki Hot Springs / Parakai trip.

Morning tea is not provided on trip days.

Fees: The cost is $20 per child for non-trip days and $35 per child for trip days. Full fees are due by Friday 2 October 2026.

Internet banking: 12-3044-0377903-00. Please use your child’s name as the reference.

If you need help with fees, please let us know. WINZ subsidies may also be available.

Please indicate the days/sessions that you are enrolling them for (Monday 5 October 2026 to Friday 9 October 2026). Wednesday 7 October 2026 is the Zoo trip and Friday 9 October 2026 is the Kaipātiki Hot Springs / Parakai trip.

If you require extended hours please write the days and the extra hours needed below. Please note extended hours will be charged at $5 per hour per child.

WINZ subsidies are available for families with one child earning up to $103,480, for two children $127,399 and for three children up to $143,312. For more information and to apply please visit the Work and Income website and let us know if you are applying. Subsidies range from $11.40 to $30+ per day.

Child(ren)'s and Caregiver Details

How many children are you enrolling?

Child 1

First NameLast Name

EthnicityDate of Birth

Gender

Child 2

First NameLast Name

Gender

EthnicityDate of Birth

Child 3

First NameLast Name

EthnicityDate of Birth

Gender

Mother/caregiver one details

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Mobile number

Area CodePhone Number

Father/caregivers two details

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

People authorised to collect your children

Will any child you are enrolling arrive at or leave Holiday Programme without a parent/caregiver or authorised adult?

Please provide the child’s name and details of the agreed arrangement, including which days they may arrive or leave independently.

Emergency contact person

First NameLast Name

Relationship to child

Mobile Number

Area CodePhone Number

Emergency contact (second person)

First NameLast Name

Relationship to child

Are there any parenting orders, protection orders, court orders or other custody/access arrangements that affect who may have contact with or collect your child?

Please provide the relevant details. PACT may contact you if we need further information to make sure the correct arrangements are followed.

Mobile Number

Area CodePhone Number

Does your child have any particular health needs we should be aware of? Eg, allergies, food requirements, asthma, medical conditions etc. Please list any medications taken or required:

Is there anything else we should know about in order to take good care of your child? Eg, special needs (including cultural), behavioural needs etc.

There are water activities included in the programme. Children will be supervised at all times. Can you please comment on your children/s confidence in the water?

Do you give permission for your child to attend the Zoo trip on Wednesday 7 October 2026 and travel using transport arranged by PACT?

Do you give permission for your child to attend the Kaipātiki Hot Springs / Parakai trip on Friday 9 October 2026 and travel using transport arranged by PACT?

PACT is a Christian organisation. Christian faith is an integral part of Legacy and is also included in Holiday Programme through age-appropriate Christian teaching, prayer, worship/devotions and open discussion about Christian faith. Are you comfortable with your child participating in these parts of PACT programmes?

I give PACT permission to provide appropriate first aid and, where necessary, arrange urgent medical treatment or ambulance transport for my child. PACT will make reasonable efforts to contact the parent/caregiver or emergency contacts if there is a significant medical concern.

Do you give permission for PACT to take and use identifiable photos and/or video of your child for PACT’s website, social media, publications, programme reporting and promotional material?

May PACT contact you about other PACT programmes, camps and activities that may be relevant to your child?

Final Declaration

I confirm that the information I have provided is true and complete to the best of my knowledge. I confirm that I have answered the permissions above and understand the choices I have made.

I will tell PACT as soon as reasonably possible if important information changes, including my child’s health or medical information, emergency contacts, custody or access arrangements, or people authorised to collect my child.

Signature

Privacy and Personal Information
In accordance with the Privacy Act 2020, the personal information collected through this form is used primarily to enrol your child and support the safe and effective operation of PACT Holiday Programme. This includes contacting parents/caregivers, managing attendance, health and safety, emergency situations, collection arrangements and programme administration.

PACT may also use information for other purposes where you have specifically given permission on this form, such as using photos or video, or contacting you about other PACT programmes, camps and activities.

Your information will be held by PACT and only accessed or shared where necessary for these purposes or where otherwise permitted or required by law.

You have the right to ask to see the personal information PACT holds about you or your child and to ask for it to be corrected if it is inaccurate or out of date.

If you have any questions about how PACT collects, uses or stores personal information, please contact us at info@pact.org.nz.

PACT Holiday Programme Enrolment Form

Parent / Caregiver Information

Enrolment Form

Child(ren)'s and Caregiver Details

Caregiver Details

Emergency Contact Details

Additional Information

Permissions and Parent/Caregiver Declaration