Plus Chartered Accountants Educare Laser Electrical Signature Homes

Breakaway Holiday Programme January 2020

List all allergies/asthma/serious illnesses/injuries or special dietary requirements or issues for your child/children
Description of any current medications and instructions for administering to your child/children, if required.
Dates of attendance. e.g Monday 19th - Friday 23rd April, Tuesday 27th - Friday 30th April 2021
Parent/Caregiver details
Permissions and Acknowledgements
I give permission for my child/children to be photographed during the Holiday Programme activities. Please note that if you give permission for your child to be photographed, these photographs may be used for reporting purposes; advertising and promotional material.

IMPORTANT: To maintain the integrity of the service and the privacy of all enrolled on the programme, mobile phones, cameras or other hand held electronic devices by participants are NOT permitted. If you require your child to have access to a mobile phone, these should be handed in to the programme coordinator at the beginning of each day and these will be returned to your child at the end of each day. Additionally, all children must bring lunch and a drink bottle every day.

The information that you have supplied is necessary for the safe and effective operation of this Break Away Holiday Programme. All personal information will be kept confidential. You are welcome to review information pertaining to your child’s enrolment at any time.

Should any of the above details change, it is essential that this BREAKAWAY programme is made aware of these changes.

reCAPTCHA is required.
Northland Cricket would like to thank its sponsors and supporters
Refining NZ Cricket Express Mainfreight Hill Construction Team Tait Hirepool Oxford Sports Trust Whangarei District Council Chilltech The Northern Advocate Grassroots Trust Dudley & Dennis Signs Recreational Services Rothbury