Application for Scholarship

Discovery for Kids Scholarship Application Details
Childs Details
Full Name *

First Name(s) Last Name Preferred Name
Date Of Birth *

Day Month Year
Date Date Picker Icon
Age *
School Year *
School Name or Education Provider *
Gender *
Ethincity *

Maori NZ European / Pakeha Other European Indian Middle Eastern / African / Latin American Asian (please specify below) Pacific Peoples (please specify below)
Physical Address *
Please include postcode
Contact Phone Number
Discovery for Kids Scholarship application for:

Please advise when future dates have been set

Parent/Caregiver Information
Parent/Caregiver 1 Full Name *

First Name Last Name
Mobile Phone *
Home Number
Please include local area code
Work Phone
PLease include local area code
Email *
example@example.com
Relationship to Child *
Parent/Caregiver 2 Full Name (if applicable)

First Name Last Name
Mobile Phone
Home Number
Please include local area code
Work Number
Please include local area code
Email
example@example.com
Relationship to Child
Are you separated or divorced

Yes No
If yes, Name of person child lives with mostly
Emergency Contact

ESSENTIAL Will only be used if parents are unable to be contacted (needs to be someone OTHER than parent/s)
Emergency Contact *

First Name Last Name
Mobile Phone *
Home Number
Please include local area code
Work Number
Please include local area code
Relationship to Child *

Personal Details
Dietary
Dietary requirements *

None Vegetarian Gluten Free Dairy Free Food Allergy (please specify) Others (please speicify)
Dietary requirement details
Medical
Medical conditions, which may affect urgent medical assistance, are:
NB: Failure to disclose relevant medical information absolves
Discovery Foundation and/or its representatives of all liability.

Family Information
Please list names and age of bothers / sisters / step siblings of your child
What would you like your whole family to gain from your discovery experience?
Please tell us anything else you want us to know:
Parent / Guardian Session
The parent sessions are a crucial part of discovery programme. It is special time for you. We specifically ask that you attend, and without other members of your family.
1. Parents/Step Parents/Grandparent/Guardian Attending:
Full Name
Relationship to Child
2. Parents/Step Parents/Grandparent/Guardian Attending:
Full Name
Relationship to Child

General
PRIVACY

Personal information
Your personal information will be held confidential to Discovery Foundation, in accordance with the Privacy Act (1993), for the purposes of Discovery courses and associated administration.You have the right to see all information held by Discovery and may ask at any time for that information to be corrected. You authorise Discovery the right to send a copy of your Feedback to your sponsors, including employers, if requested and applicable.
Database- I consent for my name to be kept on the Discovery Foundation database for the purposes of ongoing communication. *

Yes No
Promotional material - I give permission for Discovery Foundation to use images of my child for promotional purposes. I also accept that Discovery Foundation will not be liable for any unauthorized use of the images, as long as it takes all reasonable precautions to ensure the images are only used for authorized purposes. *

Yes No
Confirmation of your enrolment is subject to the child's approval from Discovery Foundation. This is to ensure your safety, the safety of others, and quality course outcomes for all. Completing this form I acknowledge Discovery will contact me by email and/or phone to complete registration: *

Yes I acknowledge this statement

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Emergency Contact