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2020 SPLASH Break-Away October Registration

Splash Break-Away is delivered by Drowning Prevention Auckland. This is a FREE holiday programme that is funded by Oranga Tamariki and delivered by Drowning Prevention Auckland.

Please note, one participant per registration. It is important that your child attends for all four days of the programme. If for any reason your child cannot attend leading up to the programme please email: splash@dpanz.org.nz to notify the team leader so they can give the spot to someone on the waiting list. 

For more information visit our websitehttps://www.watersafe.org.nz/community/holiday-programmes/
1. Please select the venue you would like your child to attend for the duration of the programme: 
Programme dates: 28th, 29th, 30th Sep & 1st Oct 

West Wave Pool & Mount Albert Aquatic Centre is fully booked. Please email splash@dpanz.org.nz to go on the 'waiting list'. 

  *This question is required.
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.
8. Please select how you heard about this programme? 
10. Registrant details  *This question is required.
This question requires a valid date format of MM/DD/YYYY.
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