Bullyproof Holiday Programme

Bullyproof Holiday Programme — Enrolment

Complete this enrolment form so we can care for your child safely and support them on the mat.
What would you like to book?

Tell us which days you want. You choose your booking and pay by card further down this form, and your place is confirmed as soon as that goes through.
Which days?
What happens next

Once you submit and your card goes through, you are confirmed. We will email a receipt straight away, and the week before the programme we will send what to bring and the drop-off routine. If anything you told us needs a conversation, we will call you first.
Child’s full legal name

First NameMiddle NameLast Name
What would you like us to call your child?
Date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
School
School year level
Martial arts experience
Parent and caregiver details
Your full name

First NameLast Name
Relationship to child
Mobile number
Please enter a valid phone number.Format: (000) 000-0000.
Email address
example@example.com
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Second contact full name

First NameLast Name
Second contact relationship
Second contact mobile
Please enter a valid phone number.Format: (000) 000-0000.
Emergency contact details
Getting home safely
Who is authorised to collect your child?
Is there anyone who must not collect your child?
What makes your child, your child
Does your child have any allergies?
What are they allergic to, and what happens?
How serious is it?
Does your child carry an EpiPen or other emergency medication?
What is it, where will it be, and when should we use it?
Expiry date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Does your child have asthma?
What triggers it, and where will the inhaler be?
Any medical conditions, diagnoses or injuries we should know about?
Does your child take any medication during the day?
Does your child learn, communicate or experience the world differently?
What helps your child have a great day with us?
What does your child look like when they are getting overwhelmed, and what helps them come back?
Is there anything about food, eating or drinking we should know about?
Is there anything about toileting or personal care we should know about?
Confidence and goals
Has your child had a hard time with bullying, teasing or friendships?
What would make these three days a win for your child?
Agreements
Photos and video
Emergency medical treatment
What we teach
Boxing block
Injury
Cancellation
Privacy
Parent or caregiver full name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Last thing
How did you hear about the programme?
T-shirt size
So we have one ready for them on day one.
Anything else you'd like us to know?

My Products

Block One, 28 to 30 September, 3 days

$175.00 NZD

Block Two, 5 to 7 October, 3 days

$175.00 NZD

Both blocks, all 6 days

$330.00 NZD

Single day, any one day

$65.00 NZD How many days

Early drop-off from 8am, whole block

$25.00 NZD

Late pick-up until 5pm, whole block

$45.00 NZD

Full extended day 8am to 5pm, whole block

$65.00 NZD

Full extended day 8am to 5pm, per day

$25.00 NZD How many days

Early drop-off from 8am, per day

$10.00 NZD How many days

Late pick-up until 5pm, per day

$18.00 NZD How many days

Enter coupon

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Should be Empty:

Bullyproof Holiday Programme — Enrolment

What would you like to book?

What happens next

Parent and caregiver details

Getting home safely

What makes your child, your child

Confidence and goals

Agreements

Last thing

My Products