WINZ OSCAR - Oranga Tamariki - ACC
Request Form
Student's Full Name
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First Name
Last Name
Student's Birthday
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Day
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Month
Year
Date
Student's School
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Parent / Caregiver Full Name:
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First Name
Last Name
Parent / Caregiver Phone Number
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Parent / Caregiver Email Address
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Second Emergency Contact Person Full Name:
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First Name
Last Name
Second Emergency Contact Person Phone Number
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Please select the service you would wish to apply for
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OSCAR WINZ
Oranga Tamariki
ACC
Are you already approved by the above service?
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Yes.
No. Please assist me with application.
my customer number is
I Agree
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Bricks4Kidz Hamilton will assist you in your WINZ/OT/ACC subsidy application, however, you acknowledge that the responsibility of the booking and the fees incurred are your sole legal responsibility, and payment of all non-subsidised portion of the fees are to be paid before the programme commences. Furthermore, outstanding fees resulting from a declined application by WINZ/OT/ACC, are your sole responsibility to pay. Outstanding amounts, which remain unpaid, will be subject to interest of 2% per month of the remaining account balance once the invoice reaches 30 days overdue. Unpaid balances may be referred to a debt collection agency, incurring additional costs that will be added to your outstanding balance.
Location would like to enrol
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Waikato Museum (1 Grantham Street, Hamilton Central)
Rototuna Chapel Hill Church (2 Cate Road, Rototuna)
Days would like to enrol
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15th April 2024
16th April 2024
17th April 2024
18th April 2024
19th April 2024
22nd April 2024
23rd April 2024
24th April 2024
26th April 2024
I Agree
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Please bring enough morning tea, lunch, afternoon tea and a refillable drink bottle.
I understand late pick ups between 4:05-5:00pm is extra $8.
I understand late pick ups after 5:00pm is charged $1 per minute.
I understand police or orange tamariki will be contacted if parent/caregiver cannot be reached after 1 hour of scheduled pick up time
Other requirements: early drop off and late pick up and lunch orders can be ordered, please contact us.
I consent for use of any photographs or video recordings that are taken of my child while participating in our programs.
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Yes
No
Signature
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Submit
Should be Empty: