Child Details

Given name

Surname/family name

Child’s official first name

Child’s official last name

Official Middle Name 1

Official Middle Name 2

Birth Date

Gender

Residential Address

Alternative Address

Languages

Ethnicity

IWI

How did you hear about us?

Register

Have you created an enquiry account on our website before, or have another child at the centre?

Please enter your email address and we will load your previous details.

Contact(s)

Parent(s) / Guardian(s)

Add Parents / Guardians

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Occupation

Emergency contact(s)

Add emergency contact(s) other than Parent/Guardian - must be able to pickup your child.

Emergency Contacts

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Additional contact(s)

Do you have any additional people that can pickup your child? If so, please enter them here and press Next when you are done.

Contact Details

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Pickups prohibited by

Important - are there people who specifically cannot pickup your child? If so, please enter their details here.

Contacts who can not pickup your child

Title

Relationship

First Name

Last Name

Mobile

Daytime Phone

Evening Phone

Personal Email

Address

Please note: A copy of any court document/custody order and details of any custodial arrangements will be required to keep on file for staff to sight.

Health

Child's Doctor

Assign Doctor

Health

Medicines

Permissions

Please indicate below whether you give permission for your child to:

I give permission for my child to attend local walks

I give permission for my child to be seen by the ear caravan, health nurse, specialists and/or plunket on site

I give permission for my child to be taken to a medical centre or hospital in an emergancy.

I give permission for images of my child to be used for planning

I give permission for images of my child to be used for teacher training/study.

I give permission for images of my child to be used in Back 2 Basics newsletters and notices.

I give permission for images of my child to be used for advertising.

Can Use Image for Playground

Custom Fields

Enrolment

Please choose the dates and days below. Note the service may require you to enrol a certain number of days.

Start date

Last day

Mon From

Mon To

Mon Ece hrs

Tue From

Tue To

Tue Ece hrs

Wed From

Wed To

Wed Ece hrs

Thu From

Thu To

Thu Ece hrs

Fri From

Fri To

Fri Ece hrs

Sat From

Sat To

Sat Ece hrs

Sun From

Sun To

Sun Ece hrs

Mon Session

Tue Session

Wed Session

Thu Session

Fri Session

Sat Session

Sun Session

Enrolment Uploads

Choose file to upload

Child Details

Register

Contact(s)

Parent(s) / Guardian(s)

Reuse Contact Details

Add Parents / Guardians

Emergency contact(s)

Reuse Contact Details

Emergency Contacts

Additional contact(s)

Reuse Contact Details

Contact Details

Pickups prohibited by

Reuse Contact Details

Contacts who can not pickup your child

Health

Child's Doctor

Health

Medicines

Permissions

Permissions

Custom Fields

Custom Fields

Enrolment

Enrolment

STATUTORY HOLIDAYS/ TERM BREAKS

Enrolment Uploads

Back 2 Basics Childcare

Back 2 Basics Childcare