HOLIDAY CLUB > Enrolment Form

Enrolment Form

To enrol in our Holiday Club programme please complete the online form below or download, complete and return the following PDF form:

Child’s Name
Child’s DOB Date Selector
Male
Female
Parent’s/Guardian’s Name
Address
Phone (daytime)
Phone (evening)
Phone (mobile)
Email
School attended
Week(s) required
Week 1
Week 2
Days Required
Full Week
Monday
Tuesday
Wednesday
Thursday
Friday
Emergency Contact 1
Please include name, and home, work and mobile phone numbers
Emergency Contact 2
Please include name, and home, work and mobile phone numbers for each person
Other Authorised Adults to pick up children
Please include name, relationship to child, and home, work and mobile phone numbers for each person
Family Doctor
Family Doctor Phone
Health Record
Please specify allergies and ailments (eg asthma, bee stings, food, penicillin, epilepsy), medical conditions, and assistance required
Medication
To be provided by parent/guardian. Please include dosage amount.
Is there any other information the Programme should be aware of?
Declaration
I accept the terms and conditions set out below.
1. I acknowledge that ASB Stadium Staff will run the After-School Programme.2. I agree to these Staff seeking medical aid for my child/ren enrolled on this Programme, if such aid is considered necessary by these staff. I shall meet any cost incurred in obtaining such aid. 3. I agree to all Staff administering the medication as prescribed in the enrolment form above, and will train staff if necessary. 4. I agree not to enrol any child/ren on the Programme who is sick, and understand that a sick child will not be able to attend. 5. I agree to inform the Staff of any known medical condition which is infectious or contagious, to assure that appropriate precautionary action can be taken. 6. I agree to provide adequate health protection equipment/aids for my child, eg. sunblock, insect repellent, etc. 7. I understand that the Programme Staff will exercise all reasonable care in respect of my child/ren during the Programme for which they are enrolled but not withstanding I agree that the ASB Stadium will not be in any manner liable for any injury or accident suffered by my child/ren or for any damage to or loss of their possessions incurred during such Programme. 8. I understand that extra charges may be incurred if my child/ren is not collected as agreed. 9. In the case of an emergency, parents will be contacted immediately and the child taken to the nearest Accident & Emergency Clinic for treatment. Information on this form is for the purposes of contacting the Parent/Guardian/Doctor in case of emergency, and for the administration of the Programme.
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