Energy Kids Holiday Club Registration Form
This form will register your child/children for our upcoming primary school Holiday Club. Please answer all questions to the best of your knowledge. Thank you
Please enter your child(ren)'s name, gender, date of birth and school year in the space below
Please enter your street address
We can provide transport for children in the local area (2304) providing they do not require a child or booster seat. Does your child(ren) require transport?
Contact Phone Number(s)
How did you hear about Energy Kids Primary School Holiday Club?
I consent for images of my child/children being used in media (e.g. church website, church Facebook page, next year's promotional material)
No, please do not use any images of my child
EMERGENCY CONTACT NAME AND PHONE NUMBERS
Who should we call during Holiday Club hours?
In the event of an emergency, I hereby give permission for the Holiday Club Leaders to seek professional medical attention/assistance and use my Medicare number for the required medical service(s).
Please type your Medicare number below
Please advise details of any existing medical conditions including food allergies and intolerances, and treatment details if necessary.
BY TYPING (or signing if filling out paper form) YOUR FULL NAME BELOW YOU ACKNOWLEDGE:
I hereby give permission for my child/children to attend the Energy Kids K-6 Holiday Club from 5 Oct - 7 Oct 2016. I have read and completed this registration form to the best of my knowledge and understand that supervision is not provided before or after the programme hours of 9am and 12pm.
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