Skip survey header

2022 July Splash Break-Away Registration 11-17 year olds - Oranga Tamariki West Wave

2022 July Splash Break-Away Holiday Programme - Oranga Tamariki West Wave

Splash Break-Away is delivered by Drowning Prevention Auckland. This is a FREE holiday programme funded by Oranga Tamariki. 

This form is to register your child's interest in attending Splash Break-Away Holiday programme for July 2022 at West Wave Pool.

The dates for our Splash Break-Away Holiday programme will be 18th, 19th, 20th, 21st July 2022


For more information visit our websitehttps://www.dpanz.org.nz/community/holiday-programmes/
1. Participant Information. *This question is required.
Gender *This question is required.
Ethnicity 
Age 
2. Parent/Guardian/Caregiver  *This question is required.
This question requires a valid email address.
3. Emergency Contact 1
This question requires a valid email address.
4. Would you like to sign up to receive water safety news and invitations to events and educational programmes from Drowning Prevention Auckland. *This question is required.
5. Parent/caregiver Statement. (Please tick each box that applies to your child, or the child you are registering)  *This question is required.
6. Does your child, or the child you are registering, have any health/support needs that the provider (Drowning Prevention Auckland) needs to be aware of, including asthma, bee sting, food allergies and/or autism. *This question is required.
9. Please select how you heard about this programme?  *This question is required.
10. Why is your child doing the programme? *This question is required.
11. Have you or anyone in your family been affected by drowning? *This question is required.
12. If yes, would you be open to sharing your experience with us?

Note: Someone from Drowning Prevention Auckland will contact you for more information
13. Can we take photos/videos of your child participating in the SPLASH Break-Away programme? (This will be used for promotion and/or reporting purposes) *This question is required.
15. Parent/Guardian/Caregiver Signature *This question is required.
Clear
Signature of