Holidays CHILD ONE'S DETAILS Child's Name (full name): Gender: MaleFemale Age: ---91011121314 Date of birth: School: Year at School 2015: ---Year 6Year 7Year 8Year 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 DaysMonTueWedThuFri Week 2 (8:30-3:00pm) Please tick days attending $45 per day and full week attendance $190 All DaysMonTueWedThuFri CHILD TWO'S DETAILS Child's Name (full name): Gender: MaleFemale Age: ---91011121314 Date of birth: School: Year at School 2015: ---Year 6Year 7Year 8Year 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 DaysMonTueWedThuFri Week 2 (8:30-3:00pm) Please tick days attending $45 per day and full week attendance $190 All DaysMonTueWedThuFri CHILD THREE'S DETAILS Child's Name (full name): Gender: MaleFemale Age: ---91011121314 Date of birth: School: Year at School 2015: ---Year 6Year 7Year 8Year 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 DaysMonTueWedThuFri Week 2 (8:30-3:00pm) Please tick days attending $45 per day and full week attendance $190 All DaysMonTueWedThuFri 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? YesNo Any other comments: AGREEMENT / SUBMISSION I Have Read And Accept the Terms And Conditions (Holiday Programme only). Please check you have filled in all fields and then click "submit" button or "clear" to start over. You will receive a confirmation email followed by a letter.
