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Online Enrolment Form
Child's full name
*
Child's gender
*
Male
Female
Child's date of birth
*
Teacher's name
Medical conditions (ie. allergies or food restrictions)
*
Personal details (ie. parents separated, dual custody, special needs etc)
Starting date at Mission Kids
*
Parent/Caregiver (1)
*
Home phone
*
Work phone
*
Mobile
*
Address
*
Email address
*
Parent/Caregiver (2)
Home phone
Work phone
Mobile
Address
Email address
Emergency contact person's full name
*
Relationship to the child
*
Home phone
Work phone
Mobile
Address
List of people who are authorised to collect your child
*
NB: Your child will not be released to anybody else without your permission.
Breakfast Club enrolment (7-8am)
Monday
Tuesday
Wednesday
Thursday
Friday
Afterschool early session enrolment (3-4pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Afterschool full session enrolment (3-6pm)
Monday
Tuesday
Wednesday
Thursday
Friday
Extramural Activities Term 2 2012
Piano (20 mins)
Piano (30 mins)
Violin (20 mins)
Violin (30 mins)
Violin (40 mins) GROUP
Guitar (20 mins)
Guitar (30 mins)
Guitar (40 mins) GROUP
Soccer
Fine Art
Dance
Easter Holiday Programme 9am - 3pm
Tuesday 10th April
Wednesday 11th April
Thursday 12th April
Friday 13th April
Monday 16th April
Tuesday 17th April
Wednesday 18th April
Thursday 19th April
Friday 20th April
Easter Holiday Programme 8am - 6pm
Tuesday 10th April
Wednesday 11th April
Thursday 12th April
Friday 13th April
Monday 16th April
Tuesday 17th April
Wednesday 18th April
Thursday 19th April
Friday 20th April
Any additional comments
Legal disclaimer
*
I agree
I/we have read and agree to the Terms & Conditions of the Mission Kids before, after school care and holiday programme. Mission Kids has a NO REFUND policy. I/we agree that we will be charged for days for which my child is enrolled, regardless of attendance. There are NO REFUNDS for absences. I/we agree to inform the programme immediately of any changes to enrolment information. I/we give permission for staff to treat our child for minor injuries. In the event of a serious accident, I understand that an ambulance will be called at our expense. I/we give permission for staff to apply sunscreen to our child during the summer months. I/we agree that while every care is taken to ensure the safety of the children at all times, the staff and management of this programme and the Mission Heights Primary & Junior College School Boards do not accept responsibility or personal liability in respect of any act arising out of any session or activity of the programme. I/we acknowledge that photographs of my child or items of my child’s work completed at Mission Kids before or after school programme may be used at a later date for marketing and promotional purposes and I/we hereby give my/our consent. No further permission will be required.
Privacy Act 1993: The information that you have supplied is necessary for the safe and effective operation of the Mission Kids Before & After School Care programme. All personal information requested will be destroyed at the completion of your child’s time in the programme. You are welcome to review information pertaining to your child’s enrolment at any time.
© 2012 Mission Kids