Enrolment Form

Enrolment Form
Which Programme are you enrolling for?
How many children are you enrolling?
CHILD NAME 1:

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age
e.g. 8
Gender
Ethnic Group

Other
School Attended
CHILD NAME 2:

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age
e.g. 8
Gender
Ethnic Group

Other
School Attended
CHILD NAME 3:

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Age
e.g. 8
Gender
Ethnic Group

Other
School Attended
School Attended
Parent / Caregiver Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Post Code
Mobile Number
Phone #2
Email
example@example.com
Cell Phone

Area CodePhone Number
Work Number

Area CodePhone Number
Emergency Contact 1

First NameLast Name
Relationship to Child
Emergency Contact Phone Number
Emergency Contact Email
Emergency Contact 2

First NameLast Name
Emergency Contact Phone Number
Emergency Contact Email
Emergency Contact Phone Number

Area CodePhone Number
Emergency Contact Phone Number

Area CodePhone Number
Emergency Contact Cell

Area CodePhone Number
Emergency Contact Cell

Area CodePhone Number
Who is authorised to pickup from the activity?
Name of anyone else who can pick up your child
Name of any adults not authorised to pick up your child?
Are there any known allergies?
Is there an allergy to bee stings?
Does your child suffer from asthma?
Any other medical conditions or health problems?
Is your child on medication?
Instructions/Special Needs
If there are any health conditions, behaviour, allergy, cultural or dietary requirements, please list them here.
Note: written consent is required if medication needs to be given while participating in the programme.
Medical Centre Name
Medical Centre Phone
Doctor Name
Will you be applying for OSCAR subsidy?
Is there any additional information that would help staff ensure the physical and emotional well-being of your child?
Permissions:
I understand that I need to sign my child in/out of the programme
I give permission for sun block to be applied to my child
I agree to my child being transported when required
I give permission for my child to be photographed (only for website/social media)
Note: On the booking site, you will be required to login/create account to save your dates.
Should be Empty:

Enrolment Form

Permissions: