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SEPTEMBER HOLIDAY PROGRAMME

ENROLMENT FORM Placement in the Holiday Programme is not registered until a complete Enrolment Form, including payment is received.

Please circle times and days that your child will be attending. If you intend to collect your child after 3.00pm they need to be enrolled for the period 3.00pm – 6.00pm.

CHILD DETAILS Surname: _______________________ First Name: ________________________

5 - 7 YEAR OLDS

Address: ___________________________________________________________

WEEK 1

__________________________________________________________________

TIME

MON 27

TUE 28

WED 29

THU 30

FRI 1

8–3

$25.00

$25.00

$25.00

$25.00

$25.00

3–6

$10.00

$10.00

$10.00

$10.00

$10.00

Allergies / Medical Problems / Cultural requirements: __________________________________________________________________ Age of Child: ______ CONTACT DETAILS OF PARENTS/CAREGIVERS Name: _____________________________________________________________

TOTAL

Phone: _______________ Mobile:___________________ Work :______________

WEEK 2

At times photos of your child/ren completing activities maybe taken to display on the notice board/OSCN training newsletter. Are you happy to allow this?

TIME

8–3

MON 4

TUE 5

WED 6

THU 7

FRI 8

$25.00

$25.00

$25.00

$25.00

$25.00

YES

NO

I give permission for my child to leave the school grounds for planned trips. 3–6

$10.00

$10.00

$10.00

$10.00

$10.00

TOTAL

Trips are subject to weather conditions, and may change accordingly.

Refunds will not be given for cancelling within 1 week of booked day, unless for medical reasons. (Doctors certificate will be required for refund).

YES

NO

I give my consent for my child to attend the School Holiday Programme on the days as requested. I agree to inform the programme co-ordinator prior to my child attending if I feel they may need special attention (e.g tends to wander). I understand that all programme staff will exercise due care but will not be liable for any injury, damage or loss, which my child may sustain to person or property.

Signed: _____________________________________ Date: ________________


Gladstone Sept Enrolment 5 7 2010