Kids Holiday Club EHSS • Christ Central Presbyterian Church

Registration 0

Kids Holiday Club Registration

Attendee Details

First Name *

Last Name *

Gender *

Date of Birth *

Age *

School Grade

Days Attending

My Child will be Attending:

Parent/Guardian Details

Parent/Guardian *

Relationship to Attendee *

Home Address *

Home Address Line 2

Suburb *

Postcode *

State *

Parent/Guardian Phone Number *

Parent/Guardian Email *

Confirm Parent/Guardian Email *

Church (if any)

Will you be staying for the duration of the Holiday Club?

Emergency Contact Details

Emergency Contact Name *

Emergency Contact Relationship to Attendee *

Emergency Contact Phone Number *

Name Emergency Contact 2

Emergency Contact 2 Relationship to Attendee

Emergency Contact 2 Phone Number

Payment

$8 per day ($24 for full 3 days)

$16 per day total for 2 or more children ($48 for full 3 days)

Please make payment at the time of registration if there are any financial issues feel free to contact Rebecca Scott on 0418 728 669.

In the payment description, please put your child's first initial, surname and KHC to the reference eg JBloggKHC (it's really important that there is a description as it needs to be clear what the money coming in is for.

Account Name: Christ Central Presbyterian Church
BSB Number: 034083
Account Number: 229374
Transfer Description: JBloggKHC

Please select a payment option

Your agreement with Christ Central Presbyterian Church

You acknowledge the following:
1. Privacy: Protecting your privacy is important to us. The information we seek allows us to manage risk, provide reasonable care and administer involvement in our program. We will not disclose personal information to any third party, unless compelled by law, but provide it only to those who are acting on behalf of the Christ Central Presbyterian Church who need it to enable them to perform their approved activities (e.g. Camp Director, First Aid offcer). Unless you explicitly advise otherwise, you consent to appropriate use by us of photographs taken on the program that include your child, including inclusion in our newsletter, web page or a brochure. You also consent to appropriate electronic communication with your child prior, during and after the camp, in keeping with the PCQ Communication Policy

2. Medical: You also acknowledge that while the Christ Central Presbyterian Church and its agents will make every reasonable effort to minimise exposure to known risks, every hazard associated with activities cannot be foreseen or may be beyond the control of the Christ Central Presbyterian Church and its agents. In the event of any emergency where your nominated contact people are unavailable, you authorise the Christ Central Presbyterian Church and its agents to obtain medical advice and/or assistance which they deem necessary. You further authorise qualified practitioners to administer anaesthetic if required. You accept all operation, blood transfusion and/or anaesthetic risks involved in the event that such procedures are deemed necessary. You accept the responsibility for payment and agree to pay medical, transport and any other related expenses. You confirm that the information contained in this online registration is true and correct. You agree to inform the Holiday Club Director of any change to these details. You are welcome to contact Rebecca Scott (0418 728 669) in relation to issues regarding your personal information and you can read our Privacy Policy at christcentral.org.au/privacy.

PARENTAL PERMISSION

I understand that by clicking 'SUBMIT' I give permission for my child to attend this Holiday Club

Date