Holiday Programme Registration Please complete the form below for each child separately Camper’s Name * First Name Last Name Preferred Name Please specify if this is your biological child or a child in care. * BiologicalIn care Camper’s Date of Birth * Please note that you must enter the month before the date. MM DD YYYY Camper’s Sex * MaleFemale My Camper’s in… * Year 1Year 2Year 3Year 4Year 5Year 6 When did your camper first enter care? When did your camper enter your care? Please detail below the hours your camper will attend each day Monday Tuesday Wednesday Thursday Friday Camper’s Emotional/Behavioural History Aggressiveness OftenSometimesNever Biting OftenSometimesNever Eating Disorders OftenSometimesNever Hyperactive OftenSometimesNever Learning Disabilities OftenSometimesNever Lying OftenSometimesNever Runs Away OftenSometimesNever Sexual Acting Out OftenSometimesNever Stealing OftenSometimesNever Tantrums OftenSometimesNever Withdrawn OftenSometimesNever Any further details or additional history Caregiver’s Name * First Name Last Name Mobile * Email Address * Home Address * I am a caregiver through * Oranga TamarikiOpen Home FoundationHomes of HopeOther Social Worker’s Name and Email * Social Worker’s Mobile * Physician’s Name * Physician’s Number Please Indicate Any Known Health Conditions/Allergies * Emergency Contact Name and Relationship * Emergency Contact Mobile * Thank you! We will contact you within 48 hours of receiving registration.