SPRINGWOOD OSHC VACATION CARE ENROLMENT FORM

Size: px

Start display at page:

Download "SPRINGWOOD OSHC VACATION CARE ENROLMENT FORM"

Austin Burns
5 years ago
Views:

1 SPRINGWOOD OSHC VACATION CARE ENROLMENT FORM PLEASE FILL OUT ALL SECTIONS AND SIGN BELOW. PRE-BOOKING IS ESSENTIAL AS PLACES ARE LIMITED. All forms need to be handed in by Friday 23 March 2018 for staffing purposes. After this time, bookings will only be accepted if numbers allow. There are no cancellations for excursions or incursions. Family Name Name of Child/ren Address Date of Birth Name of Parent/s or Guardians Phone (H) and (M) Emergency Contact Name and Number Medical Issue Dietary Needs (Please note any foods your child cannot eat.) Allergies/Medication If medication is required to be administered a medication form will need to be completed. I permit my child/ren to view the below PG movies: UP with a PG rating on 6 April 2018 YES / NO Inside Out with a PG rating on 12 April 2018 YES / NO Week 1 Week 2 Dates you will be requiring care: (Please circle or use YES or NO to show what days you would like to book) 3/4/18 16/4/18 Monday 2/4/18 Tuesday 3/4/18 Wednesday 4/4/18 Thursday 5/4/18 Friday 6/4/18 N/A Public Holiday YES / NO YES / NO YES / NO YES / NO Monday 9/4/18 Tuesday 10/4/18 Wednesday 11/4/18 Thursday 12/4/18 Friday 13/4/18 YES / NO YES / NO YES / NO YES / NO YES / NO Monday 16/4/18 Week 3 N/A N/A N/A N/A PFD YES / NO 2018 Vacation Care fees: Standard Day - $55.00 Early Bird Standard Day - $53.00 Incursion $68.00 Excursion $78.00 Please note: Children are not permitted to bring bikes (except on Wheelie Day), scooters, roller blades, skateboards etc. There is no heating of food in the microwave. Please note that when enrolling your child/ren into our Vacation Care Program you agree that your child will participate in all activities provided on the day. No separate supervision will be available. If you intend to send your child/ren on the excursion days, please ensure you complete the permission forms. NO PERMISSION SLIP, NO ATTENDANCE ON EXCURSION/ACTIVITY DAY. Important: This information is collected for the primary purpose of assisting staff to fulfil their role of teaching, duty of care and administration. Calvary Christian College abides by the National Privacy Act For further information, please do not hesitate to contact the College Administration. If you intend to send your child/ren on the excursion days, please ensure you complete the below permission forms. NO PERMISSION SLIP, NO EXCURSION/ACTIVITY. 1 of 6

2 OSHC SPRINGWOOD EXCURSION PERMISSION SLIP OBSTACLE OBSESSION Obstacle course at Karingal Scout Group Camping Grounds Mount Cotton. On Wednesday 4 April 2018, Vacation Care will be going on an excursion to participate in various activities and obstacle courses. If your child will be attending, please fill in the confirmation below: Venue Date Wednesday 4 April 2018 Wear/bring Children attending Start time Arrive back at school Mode of transport Karingal Scout Group Camping Grounds, Mount Cotton Enclosed running shoes, morning tea, water bottle, hat, comfortable clothes suitable for being active and getting dirty. Sunscreen if sensitive. Maximum 30 children with 3-4 staff members and possibly 1 inclusion support staff member. Staff ratio is at least 1 staff member to 8 children. 9.00am 12.30pm Bus A risk assessment has been completed and is available for you to sight at OSHC. I give permission for my child/ren in the Vacation Care excursion Obstacle Obsession on Wednesday 4 April to participate Parent/Guardian Signature Parent/Guardian Name Date OSHC SPRINGWOOD EXCURSION PERMISSION SLIP VISIT TO YURANA RETIREMENT VILLAGE On Friday 6 April 2018, Vacation Care we will be walking the children to Yurana Retirement Living to participate in various games and activities with the residents. If your child will be attending, please fill in the confirmation below: Venue Date 6 April 2018 Wear/bring Children attending Start time Arrive back at school Mode of transport Yurana Retirement Living, Springwood Enclosed shoes, morning tea, water bottle and hat. Sunscreen if sensitive. Maximum 30 children with 3 staff members and possibly 1 inclusion support staff member. Staff ratio is at least 1 staff member to 15 children. 9.45am 11.15am Walking A risk assessment has been completed and is available for you to sight at OSHC. I give permission for my child/ren to participate in the Vacation Care excursion at Yurana Retirement Living on Wednesday 6 April Parent/Guardian Signature Parent/Guardian Name Date 2 of 6

3 Kids Obstacle Obsession Training Name of Child : M / F Childs Date of Birth : Age : Parent / Guardian Name : Parent Mobile Number : Address : Parent Single Day Use Purchase of 10 Sessions Payment by : Cash $ Pre Arranged Direct Credit $ Date Paid Exercise and Health History Does your child have or have ever had any of the following? Diabetes Heart Condition Arthritis Asthma Epilepsy High / Low Blood Pressure Stroke Liver/ Kidney Condition Hernia High Cholesterol Infections/Infectious Diseases Rheumatic Fever If you have ticked any of the above, does your child have clearance from your Doctor to exercise? Yes No Copy of Certificate Yes You must consult your Doctor and obtain medical clearance prior to commencing Does your child have any known allergies? Yes No Has your child had any illness in the last 12 months? Yes No Is your child taking any prescribed medications? Yes No Please Note : It is important for you to discuss with your Doctor how these medications may interact, if at all, with exercise. Does your child have or have had any major injuries involving their : Neck Back Shoulders Hips Knees Ankles Statement ; I recognise that Obstacle Obsession is not able to provide me with medical advice with regard to my medical fitness and that this information is used as a guidance to the limitations of my ability to exercise. I have answered the questions to the best of my ability and guarantee details to be true and correct. I accept that I won t have any claim of any nature against Obstacle Obsession for any illness, injury or adverse change in medical condition or state of health arising directly or indirectly from any exercise program carried out. Signed : Name: Date : OOKTR 22/10/15 3 of 6

Waiver and Indemnity Form 0414604168 Kids Obstacle Obsession Training Childs Name : I, the undersigned, give my child permission of my own free will, to participate in Obstacle Obsession Training

4 Waiver and Indemnity Form Kids Obstacle Obsession Training Childs Name : I, the undersigned, give my child permission of my own free will, to participate in Obstacle Obsession Training program for the purpose of recreation, fitness and fun. This waiver is current for 6 months. Warning I acknowledge and agree that there may be aspects surrounding the training that may be dangerous and that accidents can happen. I also acknowledge that even with all the necessary precautions taken, minor and major injuries may occur and I voluntarily assume all risks associated with training with Obstacle Obsession. I agree that Obstacle Obsession can terminate our agreement at any time if it considers the risk too high, in the event of extreme weather or for any other reason that will protect the safety and security of the participants and spectators. I declare that I have read and understood these warnings and voluntarily accept all inherent risks and dangers surrounding obstacle training. I agree to comply with all rules and warnings during my training and I will follow any instructions or directions given by Obstacle Obsession Staff. I understand and agree that I am expected to exhibit appropriate behaviour at all times and that Obstacle Obsession can dismiss me, without refund, should my behaviour endanger the safety of another person, facility or property of any kind. I also agree to indemnify Obstacle Obsession from any and all third party claims caused in whole or in part by my negligent or intentional acts or omissions. I agree that Obstacle Obsession is not responsible for any personal items or property that is lost, damaged or stolen while I am participating in training. Exclusion of Liability In consideration of Obstacle Obsession guiding my child, I agree to waive and indemnify Obstacle Obsession, its officers, employees, agents and representatives in respect of any actions, suits, proceedings, claims, demands, losses, damages, and/or costs, arising out of an injury to my child and from any and all claims arising out of or connected with participation in the event. Payment & Cancellation Policy All payments for Training must be paid up front on due date or at your first session. Payment is by way of cash or by Direct Credit to nominated Bank Account. Obstacle Obsession BSB Account Surname and Date of session as reference please. Eg: Thomas 2606 Cancellations by a client must be made within a 12 hours notice if you are not attending any training session. Please phone or text the above number with any cancellations. All effort will be made available to you for a makeup program on request, if numbers allow on another day. Sessions are not transferable. I have read, understood, acknowledged and agreed to the above warnings, exclusions of liability, indemnity, cancellations and accept with full knowledge the likelihood of injury and accident inherent with obstacle training with Obstacle Obsession. I understand that safety is the forefront obligation of Obstacle Obsession, and every precaution is taken to prevent any injury from occurring. Parent/Carer Name : Signature : Date : I give / do not give permission for any photos of my child to be used on website or Facebook page. Session Accessories & Equipment * Casual Comfy Clothing * Enclosed Shoes to be worn at all times (joggers) * Hat * Towel * Sun Block to be applied * Water Bottle * Change of clothes if required after water activities OKTW 22/10/15 4 of 6

5 Registration and Medical Form Obstacle Training Name : M / F Address : DOB : Mobile No : Emergency Contact Name : Emergency Contact Mobile No : Exercise and Health History Do you have or have ever had any of the following? Diabetes Heart Condition Arthritis Asthma Epilepsy High / Low Blood Pressure Stroke Liver/ Kidney Condition Hernia High Cholesterol Infections/Infectious Diseases Rheumatic Fever If you have ticked any of the above, have you had clearance from your Doctor to exercise? Yes No Copy of Certificate Yes You must consult your Doctor and obtain medical clearance prior to commencing Are you currently pregnant? Yes No Have you had any illness in the last 12 months? Yes No Are you taking any prescribed medications? Yes No Please Note : It is important for you to discuss with your Doctor how these medications may interact, if at all, with exercise. Do you have or have had any major injuries involving your : Neck Back Shoulders Hips Knees Ankles Statement ; I recognise that Obstacle Obsession is not able to provide me with medical advice with regard to my medical fitness and that this information is used as a guidance to the limitations of my ability to exercise. I have answered the questions to the best of my ability and guarantee details to be true and correct. I accept that I won t have any claim of any nature against Obstacle Obsession for any illness, injury or adverse change in medical condition or state of health arising directly or indirectly from any exercise program carried out. Signed : Name: Date : OOTR 22/10/15 5 of 6

6 Waiver and Indemnity Form Obstacle Training I, the undersigned, of my own free will, undertake to participate in Obstacle Obsession Training program for the purpose of recreation, fitness and fun. This waiver is current for 6 months. Warning I acknowledge and agree that there may be aspects surrounding the training that may be dangerous and that accidents can happen. I also acknowledge that even with all the necessary precautions taken, minor and major injuries may occur and I voluntarily assume all risks associated with training with Obstacle Obsession. I agree that Obstacle Obsession can terminate our agreement at any time if it considers the risk too high, in the event of extreme weather or for any other reason that will protect the safety and security of the participants and spectators. I declare that I have read and understood these warnings and voluntarily accept all inherent risks and dangers surrounding obstacle training. I agree to comply with all rules and warnings during my training and I will follow any instructions or directions given by Obstacle Obsession Staff. I understand and agree that I am expected to exhibit appropriate behaviour at all times and that Obstacle Obsession can dismiss me, without refund, should my behaviour endanger the safety of another person, facility or property of any kind. I also agree to indemnify Obstacle Obsession from any and all third party claims caused in whole or in part by my negligent or intentional acts or omissions. I agree that Obstacle Obsession is not responsible for any personal items or property that is lost, damaged or stolen while I am participating in training. Exclusion of Liability In consideration of Obstacle Obsession guiding me, I agree to waive and indemnify Obstacle Obsession, its officers, employees, agents and representatives in respect of any actions, suits, proceedings, claims, demands, losses, damages, and/or costs, arising out of an injury to myself and from any and all claims arising out of or connected with my participation in the event. Payment & Cancellation Policy All payments for Training must be paid up front on due date or at your first session. Payment is by way of cash or by Direct Credit to nominated Bank Account. Obstacle Obsession BSB Account Surname and Date of session as reference please. Eg: Thomas 2606 Cancellations by a client must be made within a 12 hours notice if you are not attending any training session. Please phone or text the above number with any cancellations. All effort will be made available to you for a makeup program on request, if numbers allow on another day. Sessions are not transferable. I have read, understood, acknowledged and agreed to the above warnings, exclusions of liability, indemnity, cancellations and accept with full knowledge the likelihood of injury and accident inherent with obstacle training with Obstacle Obsession. Name : Signature : Date : I give / do not give permission for any photos of myself to be used on website or facebook page. Session Accessories & Equipment Towel and water bottle is required for every session. Shoes and training attire. pads if desired required by client for outdoor training. Enclosed Elbow and knee Sun protection is OOTW 22/10/15 6 of 6

Colorado Trek Paper Work Check List

Colorado Trek Paper Work Check List Please make sure you have all your paperwork before sending it in Due June 2 - Paperwork Due June 2 - Full payment of $2400 NAME HATS Release Form Adventure Experience