Skip survey header

2022 October Splash Break-Away Registration 11-17 year olds

2022 October Splash Break-Away Holiday Programme

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 October 2022 at Mt Albert Pool and West Wave.

The dates for our Splash Break-Away Holiday programme will be 3, 4, 5, 6 October at Mt Albert Pool and 10, 11, 12, 13 October at West Wave Pool.

For more information visit our website
1. Which pool location would you like your child to enrol in? *This question is required.
2. Participant Information. *This question is required.
3. Parent/Guardian/Caregiver  *This question is required.
This question requires a valid email address.
4. Emergency Contact 1 *This question is required.
This question requires a valid email address.
5. 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.
6. Parent/caregiver Statement. (Please tick each box that applies to your child, or the child you are registering)  *This question is required.
7. 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.
10. Please select how you heard about this programme?  *This question is required.
11. Why is your child doing the programme? *This question is required.
12. Have you or anyone in your family been affected by drowning? *This question is required.
13. If yes, would you be open to sharing your experience with us?

Note: Someone from Drowning Prevention Auckland will contact you for more information
14. 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.
16. Parent/Guardian/Caregiver Signature *This question is required.
Signature of