Book a School Holiday Programme

Child's First Name:

Child's Last Name:

Date of Birth:

Select Date:

Home Phone:

Cell Phone:

Email Address:

Physical Address:

Parent / Caregiver:

Allergies / Sensitivities / Learning Disabilities:

Photography Permission:

 Yes I give permission for my child to be photographed. Photographs may be used for promotional purposes

Parent / Caregiver Declaration:

I acknowledge and bear the responsibility and risk to my child participating in the activities. I have explained to my child the need to follow safety instructions, remain in areas designated by staff and refrain from behaviour that could cause injury. I acknowledge that any willful damage to equipment or property that has been caused by my child will incur an additional charge.

I give permission for my child to participate in the activities, recognising that the Village staff will do their best to ensure a safe experience. I understand that Howick Historical Village staff will be free and clear of all liability in the event that any injury, damage or loss is sustained by my child or to personal effects.

In the event of any sickness or accident, I request that qualified medical attention be obtained at my expense and that I be notified on one of the listed numbers promptly.

I realise that I am required to sign my child/ren in and out of the programme and that I should notify the staff if someone else is to collect my child.

I HAVE READ, UNDERSTAND AND APPROVE THE INFORMATION, POLICIES AND PROCEDURES ON THIS BROCHURE.

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