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Contact Form
-
Please complete for the next Holiday Programme...
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We are taking bookings now, for
28th Jan - 1st Feb 2013
.
Calendar>>
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Holiday Course electronic ENTRY FORM (one entry per child)
COURSE # ;
2
*
Indicates required field
Parents / Caregivers Name
*
First
Last
Phone Number
*
Emergency Phone Number
*
Emergency Contact Person
*
Email
*
Childs Name
*
First
Last
Choose One
*
Male
Female
Age?
*
Choose All or Any
*
Day 1 - Tennis
Day 2 - Cricket
Day 3 - Mystery Day
Day 4 - Hockey
Day 5 - Athletics
Day 1 - Tennis Day 2 - Cricket Day 3 - Mystery Day Day 4 - Hockey Day 5 - Athletics
Allergies (if any)
*
PAYMENT:
After Submitting this form electronically, you should immediately go into your electronic bank account and transfer your payment to...
03-1568-0061986-01
and include your name with the word KAIPAKI and the course number above, so we can match your entry to your payment.
Thanks, John.
eg. JOE BLOGGS - KAIPAKI - 2
Submit
UA-33168223-1