Last Name: (required)
First Name: (required)
Middle Names: (required)
Date of Birth - DD/MM/YY: (required)
Relationship to child: (required)
Home phone: (required)
Work phone: (required)
Your Email (required)
Relationship to child:
I give permission for my child to be photographed and used on our website:
I give permission for sunblock to be applied to my child:
Your child will only be released to an authorised person listed on this form (parent/ guardian and/or emergency contact).
In case of an emergency or in unforeseen circumstances, please indicate the name, address and phone number of any other person/s who you authorise to pick up your child on your behalf.
Option 1 - Name: (required)
Option 2 - Name:
Doctor phone: (required)
Doctor address: (required)
Note: if your child has no medical requirement write None below
Medical Problems: (required)
Mon 9 Jul - Rotorua Gondola, Luge & BBQTue 10 Jul - Hamilton Zoo & McLaren FallsWed 11 Jul - Rotorua Treetops, Lake & BBQThur 12 Jul - Manukau Butterfly Creek & Dinosaur KingdomFri 13 Jul - Girls Only Pampering Day
Mon 16 Jul - Velodrome / Gallagher Bike Skills Park & BBQTue 17 Jul - Rainbow Springs, Big Splash Boat Ride & BBQWed 18 Jul - 3D Trick Art, Rotorua highlights & BBQThur 19 Jul - Amazeme & BBQFri 20 Jul - Clydesdales, Pony Rides & BBQ
Direct to Bank AccountCredit Card
I agree to Zealandier Tours Terms and Conditions.