WINZ OSCAR-Oranga Tamariki - ACC Request Form

WINZ OSCAR - Oranga Tamariki - ACC

Request Form
Please select the service you would wish to apply for*

WINZ OSCAR （not applicable for Jan 2026）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:
Are you already approved by the above service？*

Yes.No. Please assist me with application.
my customer number is
I Agree*

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.
Location would like to enrol*

Hamilton Central Waikato Sport Fishing Club(499 Grantham Street, Hamilton Central)Rototuna High School(56 Kimbrae Drive, Rototuna North)
Days would like to enrol (9am-4pm)

***Full Week 1 (5 days) : 19th - 23rd Jan 20261.Monday: 19th Jan 20262.Tuesday: 20th Jan 20263.Wednesday: 21st Jan 20264.Thursday: 22nd Jan 20265.Friday: 23rd Jan 2026***Full Week 2 (4 days) : 27th - 30th Jan 20262. Tuesday: 27th Jan 20263. Wednesday: 28th Jan 20264. Thursday: 29th Jan 20265. Friday: 30th Jan 2026
Early Drop-off (from 8am)

Early Drop-off Monday: 19th Jan 2026 – $8Early Drop-off Tuesday: 20th Jan 2026 – $8Early Drop-off Wednesday: 21st Jan 2026 – $8Early Drop-off Thursday: 22nd Jan 2026 – $8Early Drop-off Friday: 23rd Jan 2026 – $8Early Drop-off Tuesday: 27th Jan 2026 – $8Early Drop-off Wednesday: 28th Jan 2026 – $8Early Drop-off Thursday: 29th Jan 2026 – $8Early Drop-off Friday: 30th Jan 2026 – $8
Late Pick-up (til 5pm)

Late Pick-up Monday: 19th Jan 2026 – $8Late Pick-up Tuesday: 20th Jan 2026 – $8Late Pick-up Wednesday: 21st Jan 2026 – $8Late Pick-up Thursday: 22nd Jan 2026 – $8Late Pick-up Friday: 23rd Jan 2026 – $8Late Pick-up Tuesday: 27th Jan 2026 – $8Late Pick-up Wednesday: 28th Jan 2026 – $8Late Pick-up Thursday: 29th Jan 2026 – $8Late Pick-up Friday: 30th Jan 2026 – $8
Lunch order Options （9 options every day):

Lunch Order Monday: 19th Jan 2026Lunch Order Tuesday: 20th Jan 2026Lunch Order Wednesday: 21st Jan 2026Lunch Order Thursday: 22nd Jan 2026Lunch Order Friday: 23rd Jan 2026Lunch Order Tuesday: 27th Jan 2026Lunch Order Wednesday: 28th Jan 2026Lunch Order Thursday: 29th Jan 2026Lunch Order Friday: 30th Jan 2026Please Specify the lunch order options here
I Agree*

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.
I consent for use of any photographs or video recordings that are taken of my child while participating in our programs.*

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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WINZ OSCAR - Oranga Tamariki - ACC