Parent/Guardian to retain this section
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AVALON SCHOOL OOSHC WINTER VACATION CARE 2009 - REGISTRATION FORM Please Attach Your Payment In Full To This Form Child’s Name ..............................................................Sex........... Date Of Birth...................CRN.................................. Child’s Name ..............................................................Sex........... Date Of Birth...................CRN................................. Child’s Name ..............................................................Sex........... Date Of Birth...................CRN................................... Address ...............................................................................…………............................................................................. Home Phone ................................CCB hours required.......................per child. School ...................................................................... Grade.................Cultural background................................... Languages Spoken................................................................................................................................................…… Does your child have any fears? (dogs, loud noises, spiders, masks)........................................................................... What are your child’s main interests?......................................................................................................................….. Mother / Custodial Parent Name.................................................................................... DOB.....................................CRN.................................. Home Phone ....................................Mobile .......................………..Email...................................................................... Address...................................................................................... ..................................................................................... Father / Custodial Parent Name.....................................................................................DOB......................................CRN..................................... Home Phone.....................................Mobile..................………….....Email..................................................................... lAddress............................................................... ……………….................................................……………… Is there anyone prohibited from contact with your child................... Person Authorised to collect child (other than above) Name.................................................................................. Contact Phone #........................... Bus #....................... Address....................................................................................... Medical Information Child’s Doctor...........................................................................................Phone ...................................................... Immunisation Status Complete Yes/No……Date of last tetanus injection………………… Does Your Child’s Suffer From Asthma.................. Epilepsy............................ Allergies.......................... ADD......................ADHD.......................... Other...................................Specify details plus action required......................................................................................... …………………………………………………………………………………………………………………………………….. Does your child take regular medication? Yes/No ........................... Please outline...................................……. Other Medical/Special Needs?.................................................................................................................... Please Tick the days to be booked Monday13TH Tuesday 8H Wednesday 9TH Thursday 10TH Friday 11TH VIVA LA FRANCE EVERYTHING FRENCH MASTER CHEF WHICH TEAM WILL MAKE THE BEST PIZZA? ZONE 3 EXCURSION BUS LEAVES @ 9.00 SCREEN PRINTING DON’T FORGET A T SHIRT XMAS IN JULY Monday 14TH Tuesday 15ND Wednesday 16RD Thursday 17TH Friday 18TH PJ PARTY WEAR YOUR FAVORITE PJs MAKE HOT CHOCOLATE, BRING YOUR TEDDY CRAZY SCIENCE FANTASTIC SCIENCE EXPERIMENTS MOVIE – EXCURSION WARRIEWOOD CINEMA ICE AGE 3 – LEAVING @ 9.00am TRIVIA MAYHEM GREAT DAY OF BRAIN TEASERS CRAFT AND FUN SPORT ACTIVITIES LET’S PARTY JUMPING CASTLE FUN AND GAMES ALL DAY Monday 21ST PUPIL FREE DAY – THIS IS AN UNSTRUCTURED DAY OF RELAXATION AND FUN Registration Fee- Term 3 Fee = $50 x No of Days x No of Children Total Due $10.00 $ CHILDCARE BENEFIT IS AVAILABLE TO ALL FAMILIES. FOR DETAILS ON HOW TO REGISTER CONTACT THE FAMILY ASSISTANCE OFFICE ON 13 61 50 OR VISIT WWW.FAMILY ASSIST.GOV.AU. BOOKINGS MUST BE PAID FOR IN FULL PRIOR TO ATTENDANCE PAYMENT CAN BE MADE BY CHEQUE, CREDIT CARD OR CASH. CCB PERCENTAGE WILL BE CALCULATED AND CREDITED/DEBITED TO ACCOUNT ON OFFICIAL NOTIFICATION FROM FAMILY ASSISTANCE OFFICE. IT IS YOUR RESPONSIBILITY TO CHECK WITH FAMILY ASSISTANCE TO MAKE SURE DETAILS ARE CURRENT. CANCELLATIONS WILL NOT BE REIMBURSED. CREDIT CARD DETAILS MUST BE SUPPLIED Card Type ___________________Card holder name_____________________________________________________Caard No. ______________________________________________ expiry date______________ Amount______________ Signature___________________________________________________________________ CCB PERCENTAGE WILL BE CALCULATED AND CREDITED/DEBITED TO ACCOUNT ON OFFICIAL NOTIFICATION FROM FAMILY ASSISTANCE OFFICE IT IS YOUR RESPONSIBILITY TO CHECK WITH FAMILY ASSISTANCE TO MAKE SURE DETAILS ARE CURRENT. CANCELLATIONS WILL NOT BE REIMBURSED. I …………………………………being the parent guardian of ………………………………… hereby give my consent to him/her attending all outings as specified on the vacation program conducted by the Avalon School OOSHC and its employees. I have read the conditions of enrolment and agree to abide by them in every respect. I acknowledge that my child will be exposed to all normal risks that may be associated with the program. We will be taking photos/videos of the children during vacation care for our scrapbook. These pictures will only be used within the centre. If you do not wish your Childs’ image to be used, please inform the co-ordinator. In consideration of the Avalon School OOSHC admitting my child to the program, I hereby agree that I will indemnify the Avalon School OOSHC its staff, its agents and keep them indemnified against all claims, demands, actions and liabilities of any kind arising other than wilful negligence in the course of my child’s participation in the program. I authorise AVALON SCHOOL OOSHC its staff, and agents in the event of any accident or illness to obtain such ambulance, medical and hospital assistance as seen as required by its staff and agents, and agree to meet and expenses thereby incurred. I understand that all personal information provided will be kept strictly confidential. I authorise the administration of one dose of paracetamol should my Childs temperature exceed 38.5 YES………… NO………… please tick Signature of parent/Guardian………………………………..Dated………………………………….. USING THE BOXES BELOW, LIST AT LEAST TWO PEOPLE AUTHORISED TO COLLECT YOUR CHILD AND/OR WHO WE MAY CALL IF WE CANNOT FIND YOU IN AN EMERGENCY PERSONS NAME RELATIONSHIP TO CHILD HOME PHONE MOBILE WORK PHONE Daily pickup EMERGENCY PICKUP --------------------------------------------------- Parent/Guardian to retain this section CONDITIONS OF ENROLLMENT - IMPORTANT PLEASE READ CAREFULLY! This enrolment form and indemnity to be FULLY completed before your child/children can be accepted to the vacation care program. All fees must be paid at time of booking. Days booked are only confirmed with receipt of payment - there are no refunds or credits during vacation care.. Vacation care bookings will not be accepted when there are outstanding fees from the previous term. Our opening hours are strictly from 7.30am – 6.30pm a late fee of $1.00 per minute is applied after 6.30. This amount will be applied to your account. All details of problems, disabilities of family circumstances that may affect the child are to be included on the enrolment form. Access to the child will only be given to the persons nominated on the enrolment form. Unless written arrangement is made with the coordinator. Each child must be signed in when being left at the centre and signed out when collected. Emergency telephone numbers to be supplied and they must be up to date. Food and drink sufficient for morning tea, lunch and afternoon tea are to be provided by the parent. We do not provide food during vacation care. NO CHILD WILL BE ALLOWED TO LEAVE THE SCHOOL TO PURCHASE LUNCH OR SNACKS OR FOR ANY OTHER REASON. The parent must provide suitable clothing for the child’s protection including a hat (No hat – no outdoor play) and covered shoes NO THONGS OR BARE FEET (Children without proper footwear will not be allowed to play outside). Please make sure sunscreen is applied before children come to the centre, we will reapply regularly throughout the day. Children MUST have helmets on wheels days – NO BIKES please. Avalon OOSHC reserves the right to cancel the enrolment of any child who will not cooperate with the centre and its rules, or whose behaviour is considered a danger to themselves, other children attending, or staff members. All personal information provided will be kept confidential. For further details contact Karen McGill on 9918 9672 Avalon School OOSHC P.O.Box 238 Old Barrenjoey Rd AVALON NSW 2107 EXCURSION PERMISSION NOTES During the holidays we have two excursions. Please fill in a permission slip for each excursion your child will be attending. I give permission for my child/children ____________________________________to attend an excursion to _____________________________________________on________________. We will travel from the centre by private bus. Children will need to be at the centre before 9.00am, we will return no later than 3.30. Children will need to bring morning tea, lunch and afternoon tea. They will also require a refillable water bottle. Suitable clothing and a raincoat. Signed _____________________________________________Date ____________________________ I give permission for my child/children ____________________________________to attend an excursion to _____________________________________________on________________. We will travel from the centre by private bus. Children will need to be at the centre before 9.00am, We will return no later than 3.30. Children will need to bring morning tea, lunch and afternoon tea. They will also require a refillable water bottle. Suitable clothing and a raincoat. Signed __________________________________________Date ______________________________ I give permission for my child/children __________________________________________to attend short excursions within walking distance of the centre. Signe______________________________________________Date____________________________ __________________________________________________________________________________________________________________ FOR EXCURSIONS CHILDREN WILL NEED TO HAVE THE FOLLOWING:COVERED SHOES – NO THONGS OR SANDALS. SUITABLE CLOTHING. INCLUDING A RAINCOAT A REFILLABLE DRINK BOTTLE MORNING TEA, LUNCH & AFTERNOON TEA PLEASE MAKE SURE YOU PUT SUNSCREEN ON YOUR CHILDREN WHEN YOU SIGN THEM IN – WE WILL REAPPLY DURING THE DAY.
