holiday

Holiday Club

School Holiday Program · Ages 5-10 6th - 10th July

📝 Enrolment & Sign-Up Form

👧 Child Details

Child's Full Name

Date of Birth

Age

Gender

School / Year Level

👪 Parent / Guardian Details

Parent/Guardian Name

Relationship to Child

Mobile Number

Home Address

📞 Emergency Contact (other than above)

Name

Relationship

Phone

Medical, Allergies and Medication

Does your child have any allergies? (food, insect, medication, other)Please list each allergy and the reaction. Write "none" if not applicable.

Medical Conditions (e.g. asthma, epilepsy, diabetes, other)

Medication to be taken during the programName of medication, dosage, time/when to give, and storage instructions. Please hand medication to staff at drop-off, clearly labelled.

My child carries an EpiPen / auto-injector (please give details above and hand to staff)My child has an Action Plan (asthma / anaphylaxis) — a copy is attached

Doctor / GP name

Doctor phone

Medicare number

Dietary requirements (e.g. vegetarian, halal, dairy-free)

🚸 Authorised Pick-Up

Name 1

Relationship

Phone

Name 2

Relationship

Phone

✔️ Consent & Permissions

‍I consent to my child participating in all program activitiesIn an emergency, I authorise staff to seek medical / ambulance treatment for my child.‍I consent to staff administering the medication listed above as instructed.‍I give permission for photos of my child to be used in Minitown promotional material.

Parent / guardian signature (Print/Typed)

Date

Thank you! Your submission has been received!

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Holiday Club

School Holiday Program · Ages 5-10 6th - 10th July

📝 Enrolment & Sign-Up Form

👧 Child Details

👪 Parent / Guardian Details

📞 Emergency Contact (other than above)

Medical, Allergies and Medication

🗓️ Days Attending

🚸 Authorised Pick-Up

✔️ Consent & Permissions