2019 Chinese Language & Culture Camp華語育樂營 報名表

Tuesday, April 2, 2019 10:04:00 PM


              New Zealand Chinese Youth Trust


NZCYT & Si Le Holiday Programme 2019

Monday 15 to Friday 19 April

Enrolment Form

1. Child’s Name (English)                 (Chinese)    Age       Allergies / Medical / Special Needs






2. Are you Friends of Youth Trust?         Yes            No    


3. TWO daytime care-givers while the programme is running:

Name                                           Address                                       Relationship to Child   Telephone No.









Will this person collect your child at the end of the day?           Yes           No    


4. Is any other person authorised to pick up the child?

Name                                           Address                                       Relationship to Child   Telephone No.






5 Your email address for programme information & updates?   ___________________________________________


6. Agreement & Acceptance

  1. EMERGENCY CARE: I hereby authorise NZ Chinese Youth Trust to secure any emergency care required for my child (as named on this form) should this be required.
  2. I understand that my child must be SIGNED IN & OUT each day by one of the caregivers listed above. Child MAY NOT LEAVE THE PREMISES unless escorted by an authorized person unless express written permission has been given by the parent / guardian.
  3. PROMPT end-of-day pick up is necessary. Please notify staff if you will be delayed. I understand that I can discuss overtime supervision with staff and that this may carry an extra fee.
  4. I understand that my child may be asked to leave the programme if his/her behaviour becomes unmanageable. I will discuss any identified behaviour management issues with staff PRIOR to the programme.
  5. I understand that our family may be refused participation in the programme and / or charged additional fees if this agreement has been breached.


Name & Signed: __________________________Relationship to child: ___________ Date: _____________


****************************** OFFICE USE ONLY **************************************


Payment Received: $ _______________________ Staff : __________________ Date: _________________


Or pay by Direct Credit to   NZ Chinese Youth Trust

 BNZ  02-0214-0085070-00  with reference: HP + Child’s name

Please mail the enrolment Form to mtang@xtra.co.nz


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