SIGNATURE
I hereby acknowledge the terms and conditions at sportrec.qldc.govt.nz/kids.
I will supply my child with lunch, drinks, a hat and warm clothes every day they
attend the Holiday Programme My child will always be signed into
and out of the Holiday Programme I understand that my child may
be photographed for QLDC marketing purposes I understand that there
are risks associated with my children attending the Holiday Programme.
To help minimise these risks, the Holiday Programme has safety procedures,
as well as rules and boundaries for all children that must be complied with
I understand that my children will travel via GoBus Transport on ‘away’ days
QLDC is not responsible for loss or damage to children’s possessions.
WORK AND INCOME SUBSIDIES
Is this a Work and Income (WINZ) application? YES
NO
We are an Oscar accredited programme so families can apply for the
Oscar subsidy through WINZ. We encourage applications as it can
signicantly reduce the cost of the Holiday Programme for eligible
families. For more information on WINZ subsidies visit
www.workandincome.govt.nz or phone 0800 559 009.
WINZ applications will be accepted up until Thursday
17 December and must be made directly with Alexa.
Please return your completed WINZ application form and Holiday
Programme booking form to our Customer Services team, or scan and
email the forms directly to alexa.peters@qldc.govt.nz. Alexa will contact
you when your forms are ready to collect.
CHILD’S DETAILS
PARENT/CAREGIVER’S DETAILS
ALTERNATIVE EMERGENCY DETAILS
Child’s name:
Age: DOB: Sex: M F
Address:
Postcode:
Any medical conditions, allergies or behavioural difculties?
If so, please describe management techniques.
Parent/caregiver’s name:
Mobile: Secondary phone:
Email:
Name:
Relationship to child:
Mobile: Secondary phone:
Parent/caregiver: Date:
Monday 21 December
$38 $38 $10
Tuesday 22 December
$38 $38 $10
Wednesday 23 December
$40 $40 $10
Thursday 24 December
$38 $38 $10
Tuesday 5 January
$40 $40 $10
Wednesday 6 January
$38 $38 $10
Thursday 7 January
$38 $38 $10
Friday 8 January
$40 $40 $10
Monday 11 January
$38 $38 $10
Tuesday 12 January
$38 $38 $10
Wednesday 13 January
$40 $40 $10
Thursday 14 January
$45 $45 $10
Friday 15 January
$45 $45 $10
Monday 18 January
$45 $55 $10
Tuesday 19 January
$55 $45 $10
Wednesday 20 January
$40 $40 $10
Thursday 21 January
$45 $45 $10
Friday 22 January
$38 $38 $10
Monday 25 January
$55 $55 $10
Tuesday 26 January
$38 $38 $10
Wednesday 27 January
$38 $38 $10
Thursday 28 January
$40 $38 $10
Friday 29 January
$38 $40 $10
Monday 1 February
$38 $38 $10
Tuesday 2 February
$40 $40 $10
Please return this booking form in person to Customer Services at
Queenstown Events Centre, or scan each side of this booking form
and email to kids@qldc.govt.nz
$
TOTAL:
PAYMENT/CREDIT CARD DETAILS
Type of card: Visa Mastercard Expiry Date: /
Name of card holder:
Credit card number:
Signed: Date: /
Queenstown Events Centre, Joe O’Connell Drive, Frankton
T 03 450 9005 | E kids@qldc.govt.nz
sportrec.qldc.govt/kids
Juniors Seniors Late Session
PROGRAMMEPROGRAMME
BOOKINGBOOKING
FORMFORM
HOLIDAYHOLIDAY
December 2020 –
January 2021
