EWCS Camp registration form.xlsx

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1	EWCS Dural January 2023 Camp Registration Form
2	www.eppingwestchineseschool.nsw.edu.au
3	eppingwestchineseschool@outlook.com
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6	Name:				Date of Birth:
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8	Day school:				Grade in 2023:
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10	Medicare Number:				Reference Number:
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12	Mother Name				Contact number
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14	Father Name				Contact number
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16	Emergency Contact number
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18	Photo consent			Yes	No
19	(photo will be shared in camp group, or website/yearbook only)
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21	Program	1.Chinese Painting	2. Chinese Papercutting	3. Poetry Recitation	4. Subject Consultation	5 Calligraphy	6 Your choice
22	*Creative kids voucher number:
23	*We might offer Chinese Martial Arts subject to camper preference. However, we do not redeem creative kids voucher for Chinese Martial Arts.
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26	Date to attend (Put program number under the date )
27	1/9/2023	1/10/2023	1/11/2023	1/12/2023	1/13/2023
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30	1/16/2023	1/17/2023	1/18/2023	1/19/2023	1/20/2023
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33	Transport Arrangement:		1. Dural drop off		2. Dural pick up
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35	*Epping transit $10 extra		3.Epping drop off		4. Epping pick up
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37	Estimated Arrival Time:
38	1/9/2023	1/10/2023	1/11/2023	1/12/2023	1/13/2023
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41	1/16/2023	1/17/2023	1/18/2023	1/19/2023	1/20/2023
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44	Estimated Departure Time:
45	1/9/2023	1/10/2023	1/11/2023	1/12/2023	1/13/2023
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48	1/16/2023	1/17/2023	1/18/2023	1/19/2023	1/20/2023
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52	Health Concerns (Covid-19)
53	Pelase do not send your child if they are unwell in ANY way. Please be particularly mindful of the following:
54	fever, cough, sore/scratchy throad and shortness of breath. Other reported sympotoms of Covid-19 include loss of smell,
55	loss of taste, runny nose, muscle pain, joint pain, diarrhoea, nausea/vomitting and loss of appetite.
56	With doctor certificate, we will arrange make up subject to availability.
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58	Medical information(including allergy)
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62	Meals/Food
63	Breadfast, Moring tea, Afternoon tea will be provided
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65	Clothes and shoes:
66	suitable for martial arts and outdoor activities
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68	Authority To Release Information
69	Please indicate whether you give consent for the release of specific medical information as
70	is deemed necessary for staff to exercise complete Duty of Care for your child.
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72	I confirm	Yes		No
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75	Acknowledgement
76	In the event of a medical emergeny or accident, I consent to my child being transferred to the nearest hospital
77	or medical facility for treatment which may include general anaesthetic or blood transfusion and take
78	responisibility for any experses thus incurred.
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80	Please note: in case of an accident or emergency, where practicable, parents will be contacted as soon as possible.
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82	I also agree that the information provided on this form is an accurate and a complete record that would be required
83	for dealing with any situation at this activity.
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85	I have read the above acknowledgment and confirm that I have provided Epping West Chinese School with a complete
86	and up to date medical record for my child.
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88	Epping West Chinese School expects that no student enrolled at our school may possess, distribute or consume any
89	non-prescription or illicit drugs at any school activities.
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91	Both myself and my child understand and agree to abide by the School's Drug & Alcohol Expectations as detailed above.
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93	I agree		Yes		No
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96	Parent Signature:			Parent Print Name:			Date:
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100	*Maximum 40 students a day, with at least 5 staff.