Before and After School Enrolment To enrol your child/ren in our programmes, either in Palmerston North, Marton or Ohakea, please complete the form below. An individual form needs to be completed for each child. Child's Information: * Existing Customer or New enrolment * Child's Name * Child's Age * Child's Date of Birth * Location ---Palmerston NorthMartonOhakea * School attending * Classroom or Hub * Parent's/Caregiver's name * Email address * Re-enter email address * 2nd Parent/Caregiver's name * Email address * 1st Emergency Contact (Name, cell no.) * 2nd Emergency Contact (Name, cell no.) Other people authorised to collect your child * Medical Centre Name and Address * Doctor's name and phone number Any health issues/ allergies/medications/dietary requirements Diagnosis of any of the conditions stated ADHD Aspergus ASD Asthma Migraines Anxiety Enrolment Requirements * Weekly Attendance Options Before School After School Before & After school * Start date for care Morning requirements Monday Tuesday Wednesday Thursday Friday Afternoon requirements Monday Tuesday Wednesday Thursday Friday * Do Homework at ASK Yes please No thank you Additional information I give permission for my child to travel in an ASK vehicle I give permission for photos to be taken of my child to be used on the ASK website or facebook page or for advertising purposes. I understand that my child's name will not be printed with these photos unless further permission is granted from me. * I give permission for ASK staff to arrange any necessary urgent medical treatment at my cost. ---YesNo * Fees are invoiced weekly & I agree to pay them promptly. * I agree to give two weeks notice of any changes to my child’s enrolment. * If the fees remain outstanding after reasonable negotiations are not adhered to, then details will be passed on to an external debt collection agency. Any costs incurred due to the debt collection will be passed on to the parents/caregivers. * All care will be taken to provide supervision of children attending the ASK programmes. This is in accordance with ASK policies. I acknowledge by agreeing to this, that ASK staff won't be liable for any loss or damage by way of accident, injury, theft or * denotes required field Submit
