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1Get started

2Student details

3Parent details

4Extra student details

5Terms of service

6Comments or questions

Which holiday week are you interested in? *

Which days of that week are you interested in? *

Monday 16th Dec
Tuesday 17th Dec
Wednesday 18th Dec
Thursday 19th Dec

Which days of that week are you interested in? *

Monday 20th Jan
Tuesday 21st Jan
Wednesday 22nd Jan
Thursday 23rd Jan

Are you enrolling, or enquiring? *

(If you're just enquiring, we cut the form much shorter for you)

Student details *

First

Last

Gender* *

Date of birth* *

School your child attends *

Year At School* *

Is this child a current or past HHH student?* *

When was last term this child was a HHH student?* *

Parent / bill payer details *

First

Last

Email *

Phone number* *

Emergency contact details *

First

Last

Emergency contact's phone number* *

Does your child have any learning difficulties we need to be made aware of? *

If you answered ‘yes’ regarding learning difficulties, please give some details

Does your child have any medications/allergies we need to be made aware of? *

If you answered ‘yes’ regarding medications/allergies, please list medication

Would you like us to provide lunch each day for your child (additional $13 per day)? *

Are you OK with your child’s image being used in HHH marketing material? *

I have read and agree to the Terms of Service below

KEY CONTACT:

Erica Kröger will be running the Holiday Programme. Erica can be contacted on 020 111 2020 and will have her phone on all day, please call if you need to.

DETAILS:

Head Held High Holiday Programmes during the summer holidays, 2019/2020 will be held at:

• 16th – 19th December, ACG Parnell College, Drama Room (Titoki). 9am – 3pm.

• 20th – 23rd January, Ponsonby Community Centre. 9am – 3pm.

Children must be dropped off and picked up from their venue promptly please. Start time at 9am and finish at 3pm.

PAYMENT: You will be invoiced on enrolment.

Head Held High reserve the right to cancel the programme for any reason and issue refunds to those already paid.

PLEASE BRING EACH DAY:

• Morning tea, lunch (unless paying extra for this to be provided) and afternoon tea.

• Large water bottle.

• Participants will not be allowed to leave the premises under any circumstances so there will not be facility to purchase food.

• Medication if required. Please complete the administration of medication section earlier in this form if you need to consent to Head Held High supervisors administering medication.

All personal items are the responsibility of the individual and we take no responsibility for any loss or damage.

Any message or comments for us?

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