Set sail! September Kids at the Creek 2023 • Deep Creek Anglican Church

Set sail this September and join us for our Kids at the Creek Holiday program!

Join us as we learn about what the great treasure is in our life!

18th-19th September 9:30am-1:30pm.

What you can expect:

Games - Activites - The Gospel - Morning Tea - Things to take home - And so much more!

$15 per child per day. Family prices are available!

Any questions please contact Nick on 0437863022, or nick@deepcreekanglican.com

Date & Time

18 September, 2023 9:30 AM - 19 September, 2023 1:30 PM

29 out of 60 remaining tickets available

Type

Price

Quantity

Both days

Price
$30.00

Quantity
Family A - both days, 2 kids

Price
$50.00

Quantity
Family B - both days, 3 kids

Price
$70.00

Quantity
Monday only

Price
$15.00

Quantity
Tuesday only

Price
$15.00

Quantity

Both days 0

Kids at the Creek - Holiday Club - September 2023

Kids at the Creek is to be held at Deep Creek Anglican Church (460 Blackburn Rd, Doncaster East)

Contact Nick on 0437863022 or at nick@deepcreekanglican.com

Please note: all details on this form are securely recorded. If you have signed up for Holiday Kids Club electronically before, then you only need to record the name of your child, school grade, days to attend and update contact details (i.e. email, phone number, emergency details).

Child's first name *

Last Name

Date of Birth *

Primary School *

Grade *

Gender

Home Address

Home Postcode

Email Address of main adult contact for child *

Does the child identify as Aboriginal or Torres Strait Islander?

Family tickets - Please include details for all additional children

Child 2- Full Name

Child 2 - Date of birth

Child 2 - School and grade

Child 3 - Full Name

Child 3 - Date of birth

Child 3 - School and grade

Contact Details

Parent/carer 1- Name *

Parent/carer 1 - Phone Number *

Parent/carer 2 - Name

Parent/carer 2 - Number

Adults with permission to collect - names and numbers *

Emergency Contact Details

Emergency Contact *

Emergency Contact (Relationship to Participant) *

Emergency Contact Number (Home) *

Health Details

Dietary

Allergies and Intolerances

Dietary Notes - Please specify for each child

Tip: Please add any additional dietary information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Medical

Medical Conditions *

Medical note - please specify for each child

Tip: Please add any additional medical information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Allergies/intolerances to medications or first aid (eg, bandaid adhesive)

Are medications required to be carried?

Will program leaders be required to administer carried medication?

I give permission for leaders to administer carried medication. I do this by listing all required details below - Name of medication, dosage, time to be administered, method notes (with water, chewable tab etc)

Authority for leader to organise medical attention, please select - straight Yes and No options cover all children on form *

Date of last tetanus immunisation

Health Care Provider

Family Doctor

Family Doctor Address

Family Doctor Phone Number

Health Care Card No

Medicare No

Privacy Details

We are committed to our obligations under the Privacy Act and the National Privacy Principles.

We respect the privacy of individuals and only collect personal information about individuals to enable us to undertake our normal activities (including conducting our events and activities, invitations to attend or participate, admissions, debtor and creditor transactions, sponsorship, promotions and volunteer administration).

Individuals have a right to access their personal information held by us. We take reasonable steps to ensure that the information we hold about individuals is secure, accurate, complete and up to date and individuals are invited to contact us to correct inaccurate information.

You are not obliged to give us your personal information. However, if you choose not to provide us with all or part of the personal information requested, we may not be able to invite or permit you to attend or participate in our events or activities, provide you with or inform you about our events, activities, services or where applicable, register you as a volunteer team member.

If you do not wish to continue receiving communications from us please contact us as per the contact details on our website.

Privacy Statement Agreement *

I agree

Photo and Video Permission *

Tip: Tip: In the course of activities, if your child appears in a photograph or video taken by the church are you happy for this to be used in church services or newsletters to show our activities. (names will not be used unless additional permission is given)

Family A - both days, 2 kids 0

Kids at the Creek - Holiday Club - September 2023

Kids at the Creek is to be held at Deep Creek Anglican Church (460 Blackburn Rd, Doncaster East)

Contact Nick on 0437863022 or at nick@deepcreekanglican.com

Child's first name *

Last Name

Date of Birth *

Primary School *

Grade *

Gender

Home Address

Home Postcode

Email Address of main adult contact for child *

Does the child identify as Aboriginal or Torres Strait Islander?

Family tickets - Please include details for all additional children

Child 2- Full Name

Child 2 - Date of birth

Child 2 - School and grade

Child 3 - Full Name

Child 3 - Date of birth

Child 3 - School and grade

Contact Details

Parent/carer 1- Name *

Parent/carer 1 - Phone Number *

Parent/carer 2 - Name

Parent/carer 2 - Number

Adults with permission to collect - names and numbers *

Emergency Contact Details

Emergency Contact *

Emergency Contact (Relationship to Participant) *

Emergency Contact Number (Home) *

Health Details

Dietary

Allergies and Intolerances

Dietary Notes - Please specify for each child

Tip: Please add any additional dietary information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Medical

Medical Conditions *

Medical note - please specify for each child

Tip: Please add any additional medical information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Allergies/intolerances to medications or first aid (eg, bandaid adhesive)

Are medications required to be carried?

Will program leaders be required to administer carried medication?

Authority for leader to organise medical attention, please select - straight Yes and No options cover all children on form *

Date of last tetanus immunisation

Health Care Provider

Family Doctor

Family Doctor Address

Family Doctor Phone Number

Health Care Card No

Medicare No

Privacy Details

We are committed to our obligations under the Privacy Act and the National Privacy Principles.

If you do not wish to continue receiving communications from us please contact us as per the contact details on our website.

Privacy Statement Agreement *

I agree

Photo and Video Permission *

Family B - both days, 3 kids 0

Kids at the Creek - Holiday Club - September 2023

Kids at the Creek is to be held at Deep Creek Anglican Church (460 Blackburn Rd, Doncaster East)

Contact Nick on 0437863022 or at nick@deepcreekanglican.com

Child's first name *

Last Name

Date of Birth *

Primary School *

Grade *

Gender

Home Address

Home Postcode

Email Address of main adult contact for child *

Does the child identify as Aboriginal or Torres Strait Islander?

Family tickets - Please include details for all additional children

Child 2- Full Name

Child 2 - Date of birth

Child 2 - School and grade

Child 3 - Full Name

Child 3 - Date of birth

Child 3 - School and grade

Contact Details

Parent/carer 1- Name *

Parent/carer 1 - Phone Number *

Parent/carer 2 - Name

Parent/carer 2 - Number

Adults with permission to collect - names and numbers *

Emergency Contact Details

Emergency Contact *

Emergency Contact (Relationship to Participant) *

Emergency Contact Number (Home) *

Health Details

Dietary

Allergies and Intolerances

Dietary Notes - Please specify for each child

Tip: Please add any additional dietary information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Medical

Medical Conditions *

Medical note - please specify for each child

Tip: Please add any additional medical information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Allergies/intolerances to medications or first aid (eg, bandaid adhesive)

Are medications required to be carried?

Will program leaders be required to administer carried medication?

Authority for leader to organise medical attention, please select - straight Yes and No options cover all children on form *

Date of last tetanus immunisation

Health Care Provider

Family Doctor

Family Doctor Address

Family Doctor Phone Number

Health Care Card No

Medicare No

Privacy Details

We are committed to our obligations under the Privacy Act and the National Privacy Principles.

If you do not wish to continue receiving communications from us please contact us as per the contact details on our website.

Privacy Statement Agreement *

I agree

Photo and Video Permission *

Monday only 0

Kids at the Creek - Holiday Club - September 2023

Kids at the Creek is to be held at Deep Creek Anglican Church (460 Blackburn Rd, Doncaster East)

Contact Nick on 0437863022 or at nick@deepcreekanglican.com

Child's first name *

Last Name

Date of Birth *

Primary School *

Grade *

Gender

Home Address

Home Postcode

Email Address of main adult contact for child *

Does the child identify as Aboriginal or Torres Strait Islander?

Family tickets - Please include details for all additional children

Child 2- Full Name

Child 2 - Date of birth

Child 2 - School and grade

Child 3 - Full Name

Child 3 - Date of birth

Child 3 - School and grade

Contact Details

Parent/carer 1- Name *

Parent/carer 1 - Phone Number *

Parent/carer 2 - Name

Parent/carer 2 - Number

Adults with permission to collect - names and numbers *

Emergency Contact Details

Emergency Contact *

Emergency Contact (Relationship to Participant) *

Emergency Contact Number (Home) *

Health Details

Dietary

Allergies and Intolerances

Dietary Notes - Please specify for each child

Tip: Please add any additional dietary information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Medical

Medical Conditions *

Medical note - please specify for each child

Tip: Please add any additional medical information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Allergies/intolerances to medications or first aid (eg, bandaid adhesive)

Are medications required to be carried?

Will program leaders be required to administer carried medication?

Authority for leader to organise medical attention, please select - straight Yes and No options cover all children on form *

Date of last tetanus immunisation

Health Care Provider

Family Doctor

Family Doctor Address

Family Doctor Phone Number

Health Care Card No

Medicare No

Privacy Details

We are committed to our obligations under the Privacy Act and the National Privacy Principles.

If you do not wish to continue receiving communications from us please contact us as per the contact details on our website.

Privacy Statement Agreement *

I agree

Photo and Video Permission *

Tuesday only 0

Kids at the Creek - Holiday Club - September 2023

Kids at the Creek is to be held at Deep Creek Anglican Church (460 Blackburn Rd, Doncaster East)

Contact Nick on 0437863022 or at nick@deepcreekanglican.com

Child's first name *

Last Name

Date of Birth *

Primary School *

Grade *

Gender

Home Address

Home Postcode

Email Address of main adult contact for child *

Does the child identify as Aboriginal or Torres Strait Islander?

Family tickets - Please include details for all additional children

Child 2- Full Name

Child 2 - Date of birth

Child 2 - School and grade

Child 3 - Full Name

Child 3 - Date of birth

Child 3 - School and grade

Contact Details

Parent/carer 1- Name *

Parent/carer 1 - Phone Number *

Parent/carer 2 - Name

Parent/carer 2 - Number

Adults with permission to collect - names and numbers *

Emergency Contact Details

Emergency Contact *

Emergency Contact (Relationship to Participant) *

Emergency Contact Number (Home) *

Health Details

Dietary

Allergies and Intolerances

Dietary Notes - Please specify for each child

Tip: Please add any additional dietary information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Medical

Medical Conditions *

Medical note - please specify for each child

Tip: Please add any additional medical information that may assist our team to best care for your child. If you have booked a family ticket, please specify which child has which needs.

Allergies/intolerances to medications or first aid (eg, bandaid adhesive)

Are medications required to be carried?

Will program leaders be required to administer carried medication?

Authority for leader to organise medical attention, please select - straight Yes and No options cover all children on form *

Date of last tetanus immunisation

Health Care Provider

Family Doctor

Family Doctor Address

Family Doctor Phone Number

Health Care Card No

Medicare No

Privacy Details

We are committed to our obligations under the Privacy Act and the National Privacy Principles.

If you do not wish to continue receiving communications from us please contact us as per the contact details on our website.

Privacy Statement Agreement *

I agree

Photo and Video Permission *