School Holiday Program - July Registration Form

Children you are registering: *

Child/ Participant 1 Details:

First name: *

Last name: *

Preferred name:

Gender *

MFOther

Address: *

DOB: *

Year level: *

School attending: *

Please choose the days you would like to book for Child 1:

Monday July 14Tuesday July 15

Does your child have any allergies, including food allergies? Please list them. *

Does your child have any other health, injuries or disabilities we need to be aware of? *

Does your child carry any medication we need to be aware of? *

Does your child have any dietary requirements, cultural considerations, faith requirements we need to be aware of? *

What sports is your child interested in? *

Do you give us permission to use photos of your child in our promotional material?

Child/ Participant 2 Details:

First name: *

Last name: *

Preferred name:

Gender *

MFOther

Address: *

DOB *

Year level: *

School attending: *

Please choose the days you would like to book for Child 2:

Monday July 14Tuesday July 15

Does your child have any allergies, including food allergies? Please list them. *

Does your child have any other health, injuries or disabilities we need to be aware of? *

Does your child carry any medication we need to be aware of? *

Does your child have any dietary requirements, cultural considerations, faith requirements we need to be aware of? *

What sports is your child interested in? *

Do you give us permission to use photos of your child in our promotional material?

Child/ Participant 3 Details:

First name: *

Last name: *

Preferred name:

Gender *

MFOther

Address: *

DOB: *

Year level: *

School attending: *

Please choose the days you would like to book for Child 3:

Monday July 14Tuesday July 15

Does your child have any allergies, including food allergies? Please list them. *

Does your child have any other health, injuries or disabilities we need to be aware of? *

Does your child carry any medication we need to be aware of? *

Does your child have any dietary requirements, cultural considerations, faith requirements we need to be aware of? *

What sports is your child interested in? *

Do you give us permission to use photos of your child in our promotional material?

Child/ Participant 4 Details:

First name: *

Last name: *

Preferred name:

Gender *

MFOther

Address: *

DOB: *

Year level: *

School attending: *

Please choose the days you would like to book for Child 4:

Monday July 14Tuesday July 15

Does your child have any allergies, including food allergies? Please list them. *

Does your child have any other health, injuries or disabilities we need to be aware of? *

Does your child carry any medication we need to be aware of? *

Does your child have any dietary requirements, cultural considerations, faith requirements we need to be aware of? *

What sports is your child interested in? *

Do you give us permission to use photos of your child in our promotional material?

Child/ Participant 5 Details:

First name: *

Last name: *

Preferred name: *

Gender *

MFOther

Address:

DOB: *

Year level: *

School attending: *

Please choose the days you would like to book for Child 5:

Monday July 14Tuesday July 15

Does your child have any allergies, including food allergies? Please list them. *

Does your child have any other health, injuries or disabilities we need to be aware of? *

Does your child carry any medication we need to be aware of? *

Does your child have any dietary requirements, cultural considerations, faith requirements we need to be aware of? *

What sports is your child interested in? *

Do you give us permission to use photos of your child in our promotional material?

Parent/ Carers Details:

Title: *

MrMrsMsOther

Legal first name: *

Legal last name: *

Mobile phone: *

Home phone:

Email: *

Second Contact - If there is an emergency and you are uncontactable:

Full Name: *

Mobile phone: *

Relationship to child: *

Permission to collect child. *

I agree to the terms and conditions. *

I give consent for my child to participate in GippSport's school holiday program and agree to the terms and conditions (as ticked above).

Name: *

Date: *

Signature: *

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School Holiday Program - July Registration Form

Child/ Participant 1 Details:

Child/ Participant 2 Details:

Child/ Participant 3 Details:

Child/ Participant 4 Details:

Child/ Participant 5 Details:

Parent/ Carers Details:

Second Contact - If there is an emergency and you are uncontactable:

Payment

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