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HORNBY PLAYGROUP REGISTRATION
Child's Name
First name
Last name
Gender
Male
Female
Date of Birth
Ethnicity (New)
*
African
American
American NZ
Argentinian
Asian
Asian (other)
Australian
Australian European
Brazilian
British
Cambodian
Caucasian
Chinese
Cook Island Maori
Dutch
English
European
European (other)
European Maori
Fijian
Fijian/Chinese
Filipino
German
Indian
Indonesian
Italian
Japanese
Kikuyu
Korean
Luhya
Macau
Malaysian
Maori
Niuean
NZ European
NZ Pākehā
NZ Southeast Asian
NZ/Dutch
Pacific Islander
Pākehā Maori
Rwandan
Samoan
Scottish (British)
Singahalese
South African
Southeast Asian
Sri Lankan
Sri Lankan Kiwi
Tongan
Ukraine
Welsh
Zimbabwean
Iwi affiliation
Allergies/Medical Conditions
Group
Hornby Playgroup
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Parent/Guardian Name
First name
Last name
Persons address
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Home phone
Parent's email
Emergency Contact Person & Phone No.
Group
Hornby Playgroup
Home based carer?
Tick if appropriate: I provide 'Home based care' e.g. Barnardos, Porse
Photo Consent
Tick if you are happy for your child/ren to be used in publicity photographs.
Please check the highlighted fields
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