**HOLIDAY PROGRAM REGISTRATION FORM**

HOLIDAY PROGRAM REGISTRATION FORM

AQUA MANAGEMENT LTD

CENTRALINES SPORTS COMPLEX

SEPTEMBER 28 - OCTOBER 9, 2026

Kiwi Sport Fun Weeks

Week Days 9am - 4pm

1. PARENT / CAREGIVER

2. PARENT / CAREGIVER

1. EMERGENCY CONTACT

2. EMERGENCY CONTACT

DOCTOR & CONTACT NUMBER

HEALTH DETAILS (Allergies, diet requirements, asthma, medical conditions etc)

ADDITIONAL INFORMATION (Special needs, behavioural issues, ethnic, cultural, spiritual values and beliefs etc.)

Is your child the subject of custody or access orders? (If a parent/guardian is not authorised to collect a child we will require legal evidence).

1. PEOPLE AUTHORIZED TO PICK UP CHILDREN

2. PEOPLE AUTHORIZED TO PICK UP CHILDREN

If your child is walking/biking unaccompanied once the Holiday Program has finished, please indicate if they have your permission to leave.

Yes

**WEEK 1: My child(ren) will attend these days:

MONDAY MORNING

MONDAY AFTERNOON

FRIDAY MORNING

FRIDAY AFTERNOON

PARENT/ CAREGIVER CONTRACT:

Please read and check this contract to complete the enrolment. Should you require any further information with regards to the program or wish to see a copy of the program policies please do not hesitate to ask for one for your review.

I/We agree and acknowledge:-

I have read and understand the enrolment information.
I am aware that the service Policy and Procedures are on site for viewing at any time.
The Co-ordinator/Supervisor has my permission to arrange any necessary urgent medical treatment at my cost.
I will notify the Co-rdinator/Supervisor of any changes to enrolment information in a timely manner.
I agree to pay the fees as required in the policy and understand if I default, this will incur additional legal costs payable by me.
I agree that only the people stated on the enrolment form will be allowed to collect children. No children will leave the program unaccompanied without written permission and the agreement of the supervisor.
I agree that personal possessions are my child's responsibility when attending the holiday program. I agree that, while the program will exercise all due care, the program and staff will not be liable for accidental loss or damage to any personal property that a child has at the program.
I understand that the program management reserves the right to exclude from the program any child who is frequently disruptive, ignoring program rules, or poses a significant risk to the safety of themselves or others. The program strives to be fair, positive and consistent in helping children behave appropriately.
I understand that my child's photo may be taken while at the program and could be used for program promotional purposes. Please advise us if you have any concerns.
I understand that the program will take all reasonable precautions to protect my personal information from misuse, loss, unauthorised access, modification or disclosure. Under the Privacy Act 2020 I have the right of access to, and collection of, personal information held by the program.

I, the parent /caregiver hereby agree to my child/children partaking in the holiday program activities. I accept that Aqua Management Ltd will not be liable for any hary or injury that my child/children may incur, but understand that they will endeavour to provide a safe positive environment where risks are minimised and quality experiences are maximised.

I agree to the terms & conditions of the above contract.

The Program Hours and Fees

*8.30am to 12.30pm - Half day is $12.00 per child per half day.

*8.30am to 4pm - Full Day is $20.00 per child per day.