YMCA Central Holiday Programme
Enrolment Form 2014/15
125 Grey Street, Wanganui. (06) 349 0197
ymca@ymcacentral.org.nz
RAUKAWA ADVENTURE CENTRE HOLIDAY CAMP ENROLMENT
Place a tick in the box for the Camp/s your child will be attending
CAMP DISCOVERY: Wednesday 16th - Sunday 21st December
CAMP SUMMER FUN: Monday 12th - Friday 16th January
Childs Name:
Primary Caregivers Name:
Address:
Email Address:
Phone:
Last Tetanus Injection
I would like to share a room with:
Swimming ability
Doctor
Doctors phone
WINZ SUBSIDY
I am applying for a WINZ
subsidy
Yes
Medical Conditions / Medications or anything that may
affect participation (Additional sheet available if needed).
No
You will be required to fill out a medical consent form also if staff need
to give medication during the programme.
Bus leaves Palmerston North 7.30am and leaves Wanganui 9am sharp.
Returning Friday to Wanganui 3.30pm and Palmerston North 5:00pm.
Terms and Conditions: Policies and Procedures
Agreement
I understand and agree to the following:
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That staff may obtain emergency treatment for my child at my expense.
I give permission for photographs and videos to be taken of my child for genuine resources and publicity purposes.
I give permission for my child’s photograph to be published on the YMCA Central “Face book” web site.
Due to planning requirements, booking changes need to be made one week in advance of programme. Any cancellations of bookings made
within 7 days of programme date will incur the full attendance fee.
I must inform the office of any changes to the information provided in this form, or any additional information that should be included.
(This includes changes in attendance, change of address etc.)
I understand that parent copies of the programme policy and procedures are held at the programme for my use. Complaints procedure
information is also available on site.
While all staff and volunteers of the programme will take every care to provide proper supervision for all students, neither the paid staff nor
volunteer staff has any personal liability in respect of any act or omission arising from any session or activity of the programme.
When I no longer require care, I am required to settle my account by the end of the month.
The YMCA (it’s staff and volunteers will exercise due care, but will not be liable for any loss or damage (by way of theft, accident, injury or
otherwise) arising out of attendance at the programme.
Relevant to OSCAR programmes only: Parents must sign students out of the programme each day, unless written instructions have been
received – refer to special instructions. Programme hours are strictly 6:30am to 6.00pm. A late fee of $1 per minute will be charged for every
minute after 6.00pm.
Fees
In signing this enrolment form you (the parent / caregiver) agree to pay all fees a week in advance, an automatic payment to be setup to keep
account a week in advance, you will be responsible to meet any late fees and collection charges associated with debt recovery.
Terms and Conditions
 A $50 Deposit must be made upon enrolment.
 An automatic payments form must be completed for all registrations, the amount paid must cover the fees payable by the parent/caregiver
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(less any WINZ subsidies).
All programme fees must be paid by the end of the month following the statement date.
Those with unpaid fees will be sent a statement indicating fees are overdue.
Students will not be allowed to continue in the programme where the fees remaining outstanding.
Unpaid accounts will be referred to our debt collection agency and will incur collection costs payable by the client.
Privacy
The YMCA collects and stores information from this form to comply with the requirements of the Ministry of Social Development and Agencies who
support participants through scholarships and prizes, payment of fees or other awards (if you are a recipient of one of these awards). The
information is also used to manage internal administrative processes, and for internal reporting.
In addition, when required by statute, the YMCA releases information to Government agencies such as the New Zealand Police, Department of
Justice, Ministry of Social Development, and the Accident Compensation Corporation (ACC).
In signing this enrolment form you authorise such disclosure on the understanding that the YMCA will observe the general conditions governing the
release of information, as set out in the Privacy Act 1993.
NB: The Privacy Act came into force on 1 July 1993 with the stated aim of protecting the privacy of natural persons. It requires the Institution to
collect, hold, handle, use and disclose personal information in accordance with the twelve information privacy principles in the Act.
http://www.privacy.org.nz/people/peotop.html
Parents / Caregiver agreement: Read each section, tick if applicable and sign below.
If I fail to provide sun block for my child, I agree that the YMCA will provide Sun Block.
I consent to my child being reminded to apply sun block prior to outdoor activities.
SUN BLOCK: Parents / Caregivers must provide SUN BLOCK and a SUN HAT (not a cap) each day
Permission is granted to the YMCA to transport by Bus / Van if required during programme hours
I understand that if my child is away from the programme on a registered day, FULL FEES will still
apply for each absent day.
I give my consent for my child’s photographs to be Included on the YMCA Central “Face book”
page and for other advertising purposes.
MEDICINE CONSENT: Consent is required for medicines to be administered.
A medical sheet for extensive medication is available at the office for completion please ask.
Printed Name:
Signature:
Date:
Office Use Only: CAMP NAME: Discovery
Received by
Enrolled By
Office Use Only: CAMP NAME: Summer Fun
Received by
Enrolled By
Fee: $249 SALE PRICE
Deposit Paid and Receipt No.
Fee: $249 SALE PRICE
Deposit Paid and Receipt No.
Please tick
Please tick
Please tick
Please tick
Please tick
Gear List Raukawa Camp
Phone 06 349 0197
Personal Items
 Sheet to place over mattress
 Warm sleeping bag or sheets & several blankets
 Pillow
 Pyjamas
 Toiletries
 Beach towel and Bath towel
 Sunscreen lotion, insect repellent
 WATERPROOF Raincoat
 Underwear
 Socks
 Long pants
 Shorts
 Warm and light T-shirts
 Warm woollen or polar fleece jerseys
 Warm hat and gloves
 Sun hat
 Swimwear
 Sneakers/Tramping Boots for activities
 Water shoes/Old shoes for Kayaking/Swimming
 Water bottle (named)
 Daypack
 Plastic bag (for wet/dirty clothing)
Contact Phone Number for Camp
Ph: (06) 342 8510
Fax: (06) 342 8518
Optional Personal Items
 Polypropylene tops and bottoms
 Flashlight with good batteries
 Personal journal
 Camera and batteries/film
 Wetsuit
 Gumboots (recommended)
Not recommended
 Cell phones (there is no reception)
 Money
 Jewellery
 IPod/mp3 players
Gear for Winter/Snow Camps
 Polypropylene/thermal tops and bottoms
 Two pairs of non cotton socks
 WARM and WATERPROOOF coat
 Rain pants/ski pants
 Sunglasses/Ski goggles
 Warm hat and Waterproof gloves