Kids Holiday Club 2018
Tuesday 17th to Friday 20th July
With a Celebration Service on Sunday 22nd!

9AM - 12:30PM
St James' Anglican Church
Cnr Henry and Percival St, Carlton
Kindergarten to Year 6
Contact Sarah Munns 9587 9029
Registration closes Friday 6th July

PLEASE NOTE: Registration is not complete until you have paid for KHC 2018 - The link for payment will appear after completing this form.

Camper Details
Child 1 *
First Name
Your answer
Surname *
Your answer
Gender
School
Your answer
Year
Your answer
Days Attending
Does your child have any allergies, dietary or other special needs?
If you answered Yes to the previous question, please list:
Your answer
Child 2
First Name
Your answer
Surname
Your answer
Gender
School
Your answer
Year
Your answer
Days Attending
Does your child have any allergies, dietary or other special needs?
If you answered Yes to the previous question, please list:
Your answer
Child 3
First Name
Your answer
Surname
Your answer
Gender
School
Your answer
Year
Your answer
Days Attending
Does your child have any allergies, dietary or other special needs?
If you answered Yes to the previous question, please list:
Your answer
Parent/Guardian Details
Parent/Guardian Name(s) *
Your answer
Street *
Your answer
Suburb *
Your answer
Postcode *
Your answer
Phone *
Your answer
Email *
Your answer
Emergency Contact
other than person listed above
Name *
Your answer
Phone *
Your answer
Relationship to Child(ren) *
Your answer
Restricted Persons
Are there any custody or restricted access issues we need to be aware of?
Sign In/Out
Please indicate below who will be dropping off/collecting your child(ren) each day:
Name *
Your answer
Phone *
Your answer
I am/they are aware of the need to sign in/out at the Registration Table at St James' Anglican Hall *
Required
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