Everyone Out | Enrolment

Everyone Out Nature School - Enrolment Form

Please note that completing this enrolment form does not guarantee your child a space at the Everyone Out Nature School. For more detailed information, contact rachel@everyoneout.co.nz

We have 1 space available for this term. Enrol now if your child would like to join us in Term 3.

Term 4 2020 wait list is now open. Please complete the below enrolment form if you would like your child to attend Nature School in term 3 or term 4. Your child will be added our wait list if a space is not available.

Parent/Guardian Full Name

Email

Daytime Phone (Work or Home)

Cell Phone

Address

CHILD 1: Full Name

CHILD 1: Date of Birth

CHILD 1: School

CHILD 1: Does your child have any medical conditions including allergies? Please provide details where appropriate, including any medication they are taking.

CHILD 1: Does your child have any learning, behavioural or developmental needs that we should be aware of? Please provide details so that we can provide appropriate care and support for your child.

CHILD 2: Full Name

CHILD 2: Date of Birth

CHILD 2: School

CHILD 2: Does your child have any medical conditions including allergies? Please provide details where appropriate, including any medication they are taking.

CHILD 2: Does your child have any learning, behavioural or developmental needs that we should be aware of? Please provide details so that we can provide appropriate care and support for your child.

Emergency Contact 1 (Name, Relationship to the child, Cell Phone)

Emergency Contact 2 (Name, Relationship to the child, Cell Phone)

In addition to those listed above is anyone else authorised to pick up your child(ren)? If yes, please name

Is anyone NOT authorised to pick up your child(ren)? If yes, please name

Name and contact number of Family Doctor

PERMISSION TO ENROL: I am the legal guardian of all children listed (Please contact us directly if you wish to register more than 2 children.)

FIRST AID AND URGENT MEDICAL CARE: In the event that it is required, I consent to first aid being administered to the child(ren) enrolled. Everyone Out educators have my permission to arrange any necessary urgent medical care at my cost.

TERMS AND CONDITIONS: I have read and understood the terms and conditions of service (see link below)

Address

Thank you - your enrolment has been sent to rachel@everyoneout.co.nz

> Terms and Conditions