Holiday Programme Enrolment Form

Please complete the enrolment form below to enrol your child in our next holiday programme.

    Child's Details

    Childs Name (required)

    MaleFemale (required)

    Address (required)

    Childs Age (required)

    School (required)

    Enrolment Details

    First Week - 28th September - 2nd October

    Monday

    Enrol?

    After Care Required?

    Tuesday

    Enrol?

    After Care Required?

    Wednesday

    Enrol?

    After Care Required?

    Thursday

    Enrol?

    After Care Required?

    Friday

    Enrol?

    After Care Required?

    Second Week - 5th October - 9th October

    Monday

    Enrol?

    After Care Required?

    Tuesday

    Enrol?

    After Care Required?

    Wednesday

    Enrol?

    After Care Required?

    Thursday

    Enrol?

    After Care Required?

    Friday

    Enrol?

    After Care Required?

    Parent/Guardian Name

    Full Name (required):

    Relationship to child (required):

    Home Phone Number (required):

    Work Phone Number

    Mobile Number (required):

    Email Address (required):

    Alternative Emergency Contact

    Full Name

    Relationship to child

    Home Phone Number

    Work Phone Number

    Mobile Number

    Email Address:

    Additional Contact Person/s Who Can Collect Your Child

    First Additional

    Full Name

    Relationship to child

    Home Phone Number

    Work Phone Number

    Mobile Number

    Email Address:

    Person/s Who Are Not Permitted To Collect Your Child

    First Non Permitted

    Full Name

    Relationship to child

    Other Details & Instructions

    Medical Allergies/Conditions

    Special Diet

    Special Instructions regarding your child

    Message:

    Use of photos, videos etc for Website and Facebook?

    Please state whether you are comfortable for us to use any photos or videos that we take for advertising on our Website or Facebook page.

    AgreeDisagree (required)

    Authorisation Agreement

    In giving consent for my child/ren to participate in the planned activities, as well as any replacement activities - including transporting and walking to venues - I agree to the following conditions:

    • To inform the Programme Manager or Supervisor if my child/ren require special care or attention (medical or otherwise)
    • To complete a medical consent form if my child/ren suffers from a medical condition, or requires medication to be administered
    • For medical attention to be sought if required, at my expense, and to move my child/ren to a safer location in an emergency
    • Children must be signed in and out of the Programme, and will only be released to adults identified on the enrolment form
    • I understand that full payment is required before enrolment is accepted, and that no refunds will be issued


    Declaration

    Please check this box below if you declare the above information is correct