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Enrolment Form For School Holiday

How many Cubs would you like to enrol?

Cub details - 1

Cubs Doctor details

Medical details

Does your cub(s) have any medical conditions? (Including allergy, health, special requirements, disability)

Does your cub require a 1-on-1 support?

Cub details - 4

Cubs Doctor details

Medical details

Does your cub(s) have any medical conditions? (Including allergy, health, special requirements, disability)

Does your cub require a 1-on-1 support?

Cub details -5

Cubs Doctor details

Medical details

Does your cub(s) have any medical conditions? (Including allergy, health, special requirements, disability)

Does your cub require a 1-on-1 support?

Holiday season

Select programme:

Is your cub(s) a confident swimmer?

Wild Card Discounts(15% Off All Services)

Do you want a Wild Card?

Do you require a shuttle from home to the programme or from the programme to home?

Address for pick-up/drop off

Book a Sleepover (if there is one)

Parent/Caregivers details - 1

This field is required*

This field is required* (number only)

This field is required*

This field is required*

Parent/Caregivers details - 2 (Optional)

Emergency Contacts (required)

This field is required*

This field is required*

(Optional)
Authorised Pickup (optional)
(optional)

Are you eligible for a WINZ subsidy?

Are you a refugee? (Funding may be available)

Can we use images of your cub(s) on social media or in advertising ?(identifying names will not be included)

Would you like to receive regular E-mail updates?

I understand and accept the Terms and Conditions of Pride Lands

Permission for trip days

I give consent for my cub(s) to go on trips with the Pride Lands team during this School Holidays.
I understand the conditions of Pride Lands (see “conditions” on our website: www.pridelands.org.nz).
I agree to abide by these terms.

Survey (Optional)
How did you hear about Pride Lands?
Is there anything we could improve?
If you have any issues with the enrolment form(e.g: can not send the form), Please download this hard copy form to make your enrolment.
This Information is private and confidential. Thank you for your support.
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