WILD KIDS
After school Wildhood program
Wild Kid's Name: *
Your answer
Date of Birth *
Your answer
School (if applicable)
Your answer
If your child goes to Manly West State School would they like to catch the Walking School Bus at 3pm and JOIN Us for the walk down to Melaleuca Environmental Park as park of the Active Schools Transport program?
How WILD will you be getting? *
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email address *
Your answer
I would like to receive notifications about future Wild Kids programs and other JOIN adventures
Additional Emergency Contact Name
Your answer
Additional Emergency Contact Number
Your answer
Medicare Number
Your answer
If you have Private Health Cover:
Please enter Fund Name and Member Number below
Your answer
Has your Wild Child Ever suffered from Asthma:
If so you will need to provide an Asthma Management Plan and the necessary medical supplies to treat their symptoms
Has your Wild Child Ever suffered from any of the following conditions:
If they are Anaphylactic you will need to provide an Anaphylaxis Management Plan and the necessary medical supplies to treat their symptoms
If not Anaphylactic, please explain allergies, triggers, history and treatment here
Your answer
Has your Wild Child Ever suffered from any of the following conditions:
If you selected any of the above medical conditions, please provide details on history & management strategies:
Your answer
Is your child currently taking any medication?
If you please give details of name, dosage, timing below
Your answer
Has your wild kid ever experienced or been diagnosed with the following:
If so, please explain history & management strategies
Your answer
How did you hear about the WILD KIDS program? *
Is your Wild Kid attending with any other friends or siblings?
Your answer
I understand that participation in adventurous activities such as treasure hunts, shelter building, camouflage games, bush art, boat races, tree climbing, walking barefoot, rock skimming, animal tracking, will expose my child to risk. I also understand that he/she will be supervised by experienced staff while undertaking these activities, and that they will be able to choose their level of participation, within clear safety guidelines appropriate to age and ability. *
I give my consent for the staff of Journey Outdoors In Nature to administer such first aid medical attention as may be deemed necessary, and take me to a medical facility/ call an ambulance to transport me to treatment if required. *
Is your child happy to associate with our dog? *
Django is a very friendly, well socialised, 3 year old Labrador who likes to lick, vacuum up crumbs and wag his tail ALOT!
I am happy for my child's photograph to be taken and used in promotional materials for Journey Outdoors In Nature, including brochures, e-mails and on their website *
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