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SPLASH Break-Away April 2018 Registration

SPLASH Break-Away is delivered by WaterSafe Auckland t/a Drowning Prevention Auckland. Please note, one participant per registration. 
1. Please select your preferred location. 
2. Participant Information. *This question is required.
Gender
Ethnicity  *This question is required.
Age  *This question is required.
3. Emergency contact 1 *This question is required.
This question requires a valid email address.
4. Emergency contact 2
This question requires a valid email address.
5. Parent/Caregiver Statement. (Please tick each box that applies to your child, or the child you are registering)  *This question is required.
6. Does your child, or the child you are registering, have any health/special needs that the provider (Drowning Prevention Auckland) needs to be aware of, including asthma, bee sting and food allergies, autism, asperger syndrome. Also identify any medication your child is taking. This information is very important to ensure your child's  healthy and safety is not compromised.  *This question is required.
10. Registrant details  *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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