Oranga Tamariki - ACC Request Form

Oranga Tamariki - ACC

Request Form
Oranga TamarikiACC
ONLY government agencies for auditing purposes will have access to the below information
Student's Full Name*

First NameLast Name
Student's Birthday*

DayMonthYear
Date
Student's School*
Parent / Caregiver Full Name:*

First NameLast Name
Parent's / Caregiver's Birthday*

DayMonthYear
Date
Parent / Caregiver Phone Number*
Parent / Caregiver Email Address*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Emergency Contact Person Full Name:*

First NameLast Name
Second Emergency Contact Person Phone Number*
Other people's name pick up the child if not the two names above:
People's name NOT authorised to pick up the child:
Yes.No. Please assist me with application.
my customer number is
Bricks4Kidz Hamilton is happy to assist you with your WINZ / Oranga Tamariki / ACC subsidy application. The amount you receive depends on your family size, income, and how many hours per week your child attends our programme.Full payment is required upfront once you receive our invoice, upon submitting your booking request. When we receive the subsidy payment from WINZ/OT/ACC, we will reimburse you for the approved portion.You acknowledge that the responsibility for your booking and any associated fees is your sole legal responsibility. All non-subsidised portions must be paid before the programme begins.If your subsidy application is declined or only partially approved, any remaining balance becomes your responsibility to pay.If your child is not attending a booked session, please notify us at least 3 working days in advance. Otherwise, you will be charged the full amount in line with our enrolment policies.Any fees that remain unpaid for more than 30 days will incur interest at 2% per month on the outstanding balance. Unpaid accounts may be referred to a debt collection agency, and any additional collection costs will be added to your balance.
Hamilton Central Waikato Sport Fishing Club(499 Grantham Street, Hamilton Central)Rototuna High School(56 Kimbrae Drive, Rototuna North)
***Full Week 1 (4 days) : 7th-10th April2.Tuesday: 7th April 20263.Wednesday: 8th April 20264.Thursday: 9th April 20265.Friday: 10th April 2026***Full Week 2 (5 days) : 13th - 17th April 20261. Monday: 13th April 20262. Tuesday: 14th April 20263. Wednesday: 15th April 20264. Thursday: 16th April 20265. Friday: 17th April 2026
Early Drop-off: 2.Tuesday: 7th April 2026Early Drop-off: 3.Wednesday: 8th April 2026Early Drop-off: 4.Thursday: 9th April 2026Early Drop-off: 5.Friday: 10th April 2026Early Drop-off: 1. Monday: 13th April 2026Early Drop-off: 2. Tuesday: 14th April 2026Early Drop-off: 3. Wednesday: 15th April 2026Early Drop-off: 4. Thursday: 16th April 2026Early Drop-off: 5. Friday: 17th April 2026
Late Pick-Up: 2.Tuesday: 7th April 2026Late Pick-Up: 3.Wednesday: 8th April 2026Late Pick-Up: 4.Thursday: 9th April 2026Late Pick-Up: 5.Friday: 10th April 2026Late Pick-Up: 1. Monday: 13th April 2026Late Pick-Up: 2. Tuesday: 14th April 2026Late Pick-Up: 3. Wednesday: 15th April 2026Late Pick-Up: 4. Thursday: 16th April 2026Late Pick-Up: 5. Friday: 17th April 2026
Lunch Order: 2.Tuesday: 7th April 2026Lunch Order: 3.Wednesday: 8th April 2026Lunch Order: 4.Thursday: 9th April 2026Lunch Order: 5.Friday: 10th April 2026Lunch Order: 1. Monday: 13th April 2026Lunch Order: 2. Tuesday: 14th April 2026Lunch Order: 3. Wednesday: 15th April 2026Lunch Order: 4. Thursday: 16th April 2026Lunch Order: 5. Friday: 17th April 2026Please Specify the lunch order options here
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 timeOther requirements: early drop off and late pick up and lunch orders can be ordered, please contact us.
YesNo
Please let us know if your kid have any physical or mental problems, or any other special instructions : (any health and/or medical conditions, including what treatment is required or whether the child is self-medicating, as with asthma.)*
Signature*

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