Holiday Programme Registration

The Koru Trust 2024 ©

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CHIDRENS DETAILS
Child 1
Name *
Age *
Child 2
Name *
Age *
Child 3
Name *
Age *
ENROLMENT DETAILS
Contact email address to send further information *
Location *
Week 1 December	Mon 15th Tue 16th Wed 17th Thu 18th Fri 21st
Week 2 - January	Mon 5th Tue 6th Wed 7th Thu 8th Fri 9th
SECURITY DETAILS
Week 3 - January	Mon 12th Tue 13th Wed 14th Thu 15th Fri 16th
Week 4 - January	Mon 17th Tue 19th Wed 20th Thu 21st Fri 22nd
People authorised to collect your child(ren)
Person 1 *
Person 2
Person 3
What arrangements will be made for the sign in and out of your child/young person
GUARDIAN DETAILS
Mother
Name
Home Address
Phone - Daytime
Phone - Evening
Mobile
Father
Name
Address
Phone - Daytime
Phone - Evening
Mobile
EMERGENCY CONTACTS
Contact 1
Name *
Relationship to child *
Contact No *
Address *
Contact 2
Name
Relationship to child
Contact No
Address
DOCTORS DETAILS
Name
Phone
Address
ADDITIONAL INFORMATION
Does your child have any particular health needs we should be aware of? (eg allergies, food requirements, asthma, medical conditions etc)
Is there anything else we should know about in order to take good care of your child? (eg custody arragements, special needs, behavioural issues etc)