Holiday Kidz Club - July 2019 • Deep Creek Anglican Church

Two days of fun for children in grades prep to 6. Each day's program includes Christian teaching, games, music, craft and more.

Morning tea will be provided.

Children will need to bring lunch and water bottle

$20 per child per day

Longer day option - $23 per child per day with afternoon snack provided. (8:30am - 4:30pm)

registrations essential by Tuesday 2nd July.

Date & Time

4 July, 2019 9:00 AM - 2:00 PM

Name

Quantity

Standard Program
- Whole Event - $40.00
- Single Occurrence - $20.00
Quantity
Long Day Program (4:30pm finish)
- Whole Event - $46.00
- Single Occurrence - $23.00
Quantity

Applying discount...

Standard Program 0

Ticket Type

What dates would you like to register for?

Holiday Kidz Club - JULY 2019

The Holiday Kidz Club is to be held at Deep Creek Anglican Church (460 Blackburn Rd, Doncaster East)

Contact Susan Turner on 0412 576 324 or susan@deepcreekanglican.com

Please note: all details on this form are securely recorded. If you have signed up for Holiday Kidz 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).

First Name *

Last Name *

Gender

Date of Birth

Primary School

Grade

Contact Details

Parent's Names (if under 18) *

Phone Number

Mobile Number *

Email Address *

Home Address

Home Address Line 2

Home Postcode

Emergency Contact Details

Emergency Contact *

Emergency Contact (Relationship to Participant)

Emergency Contact Number (Home) *

Names of people allowed to collect child *

Health Details

Dietary

Dietary Needs

Vegetarian

Lactose Intolerant

Nut Intolerant

Gluten Intolerant

Celiac

Seafood Intolerant

Egg Intolerant

Vegan

Other

Dietary Notes

Medical

Date of last tetanus immunisation

Medical Conditions

Medical note

Are medications required to be carried?

Yes

Who is Responsible for Medication

Authority for leader to organise medical attention

Yes

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 *

Yes

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)

Long Day Program (4:30pm finish) 0