SCHOOL HOLIDAY PROGRAM

GENKIDS HOLIDAY PROGRAM REGISTRATION

JULY 14th - JULY 17th, 2025

PREP - GRADE 6 CHILDREN ONLY

* Indicates required field

Parent / Guardian Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

PHONE NUMBER *

CHILD 1 NAME *

CHILD 1 D.O.B *

CHILD 1 SCHOOL YEAR *

CHILD 2 NAME *

CHILD 2 D.O.B *

CHILD 2 SCHOOL YEAR *

CHILD 3 NAME *

CHILD 3 D.O.B *

CHILD 3 SCHOOL YEAR *

CHILD 4 NAME *

CHILD 4 D.O.B *

CHILD 4 SCHOOL YEAR *

DAYS ATTENDING *

MONDAY 14th JULY TUESDAY 15th JULY WEDNESDAY 16th JULY THURSDAY 17th JULY

ALLERGIES *

EMERGENCY CONTACT NAME (DIFFERENT TO PARENT / GUARDIAN ALREADY PROVIDED) *

EMERGENCY CONTACT PHONE NUMBER (DIFFERENT TO PHONE NUMBER ALREADY PROVIDED) *

MEDICARE NUMBER *

DO YOU HAVE AMBULANCE COVER? *

I agree to my family's participation in this program and understand that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers exist in the activities in which my family will be participating. I acknowledge that while the organisation and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of the organisation, its leaders and staff. In the event of any emergency where my nominated contact people are unavailable:
1. I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.
2. I further authorise qualified practitioners to administer anaesthetic if required.
3. I accept all operation, blood transfusion and/or anaesthetic risks involved in the event that such procedures are deemed necessary.
4. I accept the responsibility for payment and agree to pay medical, transport and any other related expenses.
5. I confirm that the information provided above is true and correct.
6. I agree to inform the leader of any change to these details.

I AGREE TO THE ABOVE STATEMENT AND CONDITIONS *

YES

Submit

GENKIDS HOLIDAY PROGRAM REGISTRATIONJULY 14th - JULY 17th, 2025​PREP - GRADE 6 CHILDREN ONLY

GENKIDS HOLIDAY PROGRAM REGISTRATION

JULY 14th - JULY 17th, 2025

PREP - GRADE 6 CHILDREN ONLY