Parent / Caregiver & Child Registration Form

For registrations or more information about any of our programmes, please contact:

Cecily Taufelila on 09 276 8727 or 021 190 7689

Privacy Policy

Please view our Privacy Policy at the bottom of the website

  • Personal Details (Parent / Caregiver)

  • Personal Details (Children)

  • For each extra child you wish to add, please click on the [+] button at the end of the row
    Family NameGiven Name(s)Date of Birth (DD/MM/YYYY)GenderEthnicity 
  • Contact Details

    I declare to the best of my knowledge all the information supplied on, and with this registration form is true and complete, I agree to abide by the conditions as described above and I consent to the disclosure of personal information/photos as described above. I also agree and accept responsibility for ensuring my child’s safety at all times during attendance of Rise UP Trust Programmes.
  • Use your mouse, stylus or finger to sign