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