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2023 January Splash Break-Away Registration 11-17 year olds

2023 January 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 January 2023 at;

Mt Albert Pool and West Wave - Dates: 9, 10, 11, 12 January 2023
Manurewa Pool and Pt Erin - Dates: 16, 17, 18, 19 January 2023

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