Out Of School Care & Recreation Programme

Lower Hutt – New Zealand


    Choose a programme:




    Child's details


    First name
    Please write in “Capital letter, small letters” eg Hemi. This name will appear on the register. No second names.

    Please write as “Capital letter, small letters” eg Smith.

    Date of birth


    School name

    Child's class

    Child's Year at school



    If Other, please state:


    Phone (home)

    Parents separated?

    If Yes: sole or shared custody?

    If Shared Custody please detail arrangements

    Child's doctor's name

    Child's doctor's phone


    Details of Key Parent or Caregiver #1

    Please list details for at least one parent or caregiver below.

    1. Name

    1. Relationship to child

    1. Home phone

    1. Mobile

    1. Work phone

    1. Employer's company name

    1. Employer's company address

    1. Preferred email address

    1. Alternate email address


    Details of Key Parent or Caregiver #2

    2. Name

    2. Relationship to child

    2. Home phone

    2. Mobile

    2. Work phone

    2. Employer's company name

    2. Employer's company address

    2. Preferred email address

    2. Alternate email address


    Other people authorised to collect your child from the programme:

    1. Name

    1. Relationship to child

    1. Mobile


    2. Name

    2. Relationship to child

    2. Mobile


    3. Name

    3. Relationship to child

    3. Mobile


    Medical conditions:

    Does your child have any medical issues? e.g. ADHD Medication, asthma, allergies


    Cultural / religious or other needs:

    Are there any cultural, religious or other needs we should know about? e.g. dietary or otherwise


    Extra-curricular activities:

    Current extra-curricular activities that staff may be required to collect your child from within School grounds. Please detail start and finish times and whereabouts of activity: eg Kelly Sport, Wednesday 3:15-4:30pm.



    Please select the sessions required. (For casual attendance see below)






    Start date:

    Are you applying for the OSCAR subsidy?

    Casual attendance only: Dates of attendance if known:


    Civil Emergency contacts:

    If we need to contact you, but you cannot be reached, we may need to contact your alternative emergency contacts. Please provide the names of 2 adults who you agree can be contacted in an emergency if you are not available. NB: We would prefer that these contacts live within one kilometre of the OSCAR House programme and they are available during the hours of OSCAR programme operation.

    By listing these emergency contacts, you authorise OSCAR House to contact the nominated people in the event of a civil defence emergency.

    1. Name (Not Parent/Caregiver)

    1. Relationship to child

    1. Mobile

    1. Work phone

    1. Home phone

    1. Home address (required)


    2. Name (Not Parent/Caregiver)

    2. Relationship to child

    2. Mobile

    2. Work phone

    2. Home phone

    2. Home address (required)


    Parent Contract:

    Parent/caregiver name

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