Holiday Form All * labelled fields are important CHILD ONE'S DETAILS Child's Name (full name)* Gender* Male Female Age* -- 9 10 11 12 13 14 Date of birth* School* Year at School 2018* -- Year 6 Year 7 Year 8 Year 9 Medication: Any medication required during programme is to be provided by parent/caregiver* Dosage* Programmes: Please select the days and programmes you wish your children to attend Week 1 (8:30-3:00pm): Please tick days attending $45 per day and full week attendance $190 -- All Days Mon Tue Wed Thu Fri Week 2 (8:30-3:00pm): Please tick days attending $45 per day and full week attendance $190 -- All Days Mon Tue Wed Thu Fri CHILD TWO'S DETAILS Child's Name (full name) Gender Male Female Age -- 9 10 11 12 13 14 Date of birth School Year at School 2018 -- Year 6 Year 7 Year 8 Year 9 Medication: Any medication required during programme is to be provided by parent/caregiver Dosage Programmes: Please select the days and programmes you wish your children to attend Week 1 (8:30-3:00pm): Please tick days attending $45 per day and full week attendance $190 -- All Days Mon Tue Wed Thu Fri Week 2 (8:30-3:00pm): Please tick days attending $45 per day and full week attendance $190 -- All Days Mon Tue Wed Thu Fri CHILD THREE'S DETAILS Child's Name (full name) Gender Male Female Age -- 9 10 11 12 13 14 Date of birth School Year at School 2018 -- Year 6 Year 7 Year 8 Year 9 Medication: Any medication required during programme is to be provided by parent/caregiver Dosage Programmes: Please select the days and programmes you wish your children to attend Week 1 (8:30-3:00pm): Please tick days attending $45 per day and full week attendance $190 -- All Days Mon Tue Wed Thu Fri Week 2 (8:30-3:00pm): Please tick days attending $45 per day and full week attendance $190 -- Mon Tue Wed Thu Fri PARENT/CAREGIVER'S DETAILS Parent/Caregiver 1 Name* Relationship to child* Home phone number Work phone number Cellphone number* Email* Address* Suburb* Parent/Caregiver 2 (if applicable) Name Parent/Caregiver 2 Relationship to child Home phone number Work phone number Cellphone number Email Address Suburb EMERGENCY INFORMATION (please provide two contacts different from above) Emergency contact person 1* Relationship to child* Emergency daytime phone Emergency cellphone* Emergency contact person 2* Relationship to child* Emergency daytime phone Emergency cellphone* OTHER INFO Additional people authorised to collect my child People who may not collect my child (possibly due to custodial issues) Will you be applying for WINZ? Yes No Any other comments AGREEMENT / SUBMISSION I Have Read And Accept the Terms And Conditions* Yes Send
