Summer holidays kids day camp registration form

For 5-12 year olds
Monday 7th – Friday 11th January 2013 – Fenton Park Bible Church - Cnr Ward Ave & Hilda Street All Enquiries phone Mark 3490243 or 0272066511 Parent/Caregiver Information Sheet
Kids’ holiday program is all about making friends and creating great memories. Every day we have chapel time, activity time and games time. Other activities may include discovery walks and the learning of various skills and crafts Please bring your own lunch each day. Morning and afternoon tea will be provided. . Please note: We require no fees, but a koha would be appreciated. Sign-in from 8:30 am daily. PLEASE MAKE SURE YOU DO NOT DROP OFF BEFORE 8:30AM OR PICK UP AFTER 3:00PM AS THERE IS NO SUPERVISION BEFORE REGISTRATION OR AFTER PICK UP. What to bring: Lunch, drink bottle, day bag, strong covered footwear, warm old clothes, raincoat
What NOT to bring:
Cell phones, electronic games, iPods, MP3 players, chewing gum. Do not bring any
dangerous weapons, matches or illegal substances or pets. These will be taken off children
and returned to parents.
Please note: Children who make the holiday programme a less pleasant experience for supervisors or other children (through verbal abuse, bullying, put-downs or other means) will be asked not to return for the rest of the week. In extreme circumstances the parents/caregivers may be asked to pick them up immediately. For 5-12 year olds
Monday 7th – Friday 11th January 2013 – Fenton Park Bible Church - Cnr Ward Ave & Hilda Street All Enquiries phone Mark 3490243 or 0272066511 Registration F
Child’s Name __________________________________________________________________________ Date of Birth*________________________________________________________________ Address* ___________________________________________________________________ __________________________________________________________________________ Parent or Guardian Name*_________________________________________________________ Home Phone____________________________________________________________________ Work Phone____________________________________________________________________ Mobile_____________________________________________________________________ Email______________________________________________________________________ Emergency Contact*_______________________________________________ (Incase we can not contact adult named above) Emergency Contact Phone*_______________________________________________________ I would like to be the same team with_____________________________________________ We try to put you with at least one of your friends Is there anyone who is not legally allowed access to your child? __________________________________________________________________________ Who will be picking your child up from camp?* If this changes day by day, you must notify us at the start of the day as your child will only be permitted to leave the programme with the person designated. Do they have any health conditions that may affect them while at holiday programme? __________________________________________________________________________ __________________________________________________________________________ Please tick here if we have permission to give your child Paracetamol, Panadol, Ibuprofen Please tick here if you consent to your child being sent follow up information and studies Nominated Person * (Signature will be required by Parent/Caregiver/Nominated Person over 18 years at registration) PLEASE DO NOT SEND YOUR CHILD TO THE HOLIDAY PROGRAMME IF THEY HAVE


Microsoft word - new health form - ciss.doc

Girl Scouts of Shanghai Health Information Form Thank you for filling out this form. The more complete information you provide, the better we are able to work with your child to ensure she receives correct care when needed. Name of Child: (Last, First, Middle Initial) Date of Birth: (MM/DD/YYYY) Address: District: Postal code: Parent or Guardian: Mobile Phone


Anlage zur Akkreditierungsurkunde DGA-ML-6096.00 (06.10.2009)DGA Deutsche Gesellschaft für Akkreditierung mbH Anlage zur Akkreditierungsurkunde DGA-ML-6096.00 (06.10.2009) Die Akkreditierung ist gültig bis: 05.10.2014 MVZ Diamedis GmbH Diagnostische Medizin Sennestadt Dunlopstraße 50 Husener Straße 46a 33689 Bielefeld 33098 Paderborn Untersuchungen im Bereich Medizini

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