Please note, I have an assistance dog who attends classes with me. Please keep this in mind when enrolling, if your child has an allergy to dogs.

Enrolment form

To enrol your child in one of our upcoming programmes, please complete the form below and click the 'Submit' button.

Please select which classes you would like to enrol in *

JANUARY 2019 HOLIDAY PROGRAMME (22nd Jan, 1-4pm)

CHURTON PARK TEN WEEK CLASS (term one 2019)

ISLAND BAY TEN WEEK CLASS (term two 2019)

KARORI TEN WEEK CLASS (term three 2019)

CHILD'S Name *

First

Last *

Last

CHILD'S date of birth *

Second Child's Name (optional)

Please use this option only if enrolling a sibling or other child with the same caregiver details.

Second child's date of birth (optional)

Please use this option only if enrolling a sibling or other child with the same caregiver details.

Male

Female

Does your child have any medical conditions, behavioural issues, or learning needs I may need to be aware of? If yes, please give details below

PARENT/CAREGIVER name *

Address *

Phone *

Email *

Emergency contact (in case I can't get hold of you) *

Name

Number *

Phone Number

Please name any person's other than yourself authorised to collect your child, or specify if your child has permission to walk home: *

Is there anything else you would like me to know about your child? (optional)

Mailing List

Would you like to receive updates about future classes? Check this box to receive occasional updates (through Mailchimp.) You can unsubscribe from these later if you wish.

Please check the box to say you have read and agree to the following: *

I understand that completing this form signifies enrolment in the selected programme(s) and agree to pay the fees associated with this. I understand that it is my responsibility to inform Brain Bunny Workshops if I change my mind about taking a place in any of the classes, and that failure to do so may result in me being charged a late-notice cancelation fee (please see the fees section of our website for details of this.) I herby consent to my child taking part in the workshop, and entrust the supervision of my child to the organisers for the duration of the workshop. I understand that all reasonable care will be taken to ensure the safety and well being of my child, but that in the unlikely event of accident or illness, Brain Bunny Workshops will not be held responsible for any medical or related costs.

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