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Holiday Program Registration
Hidden
Program
*
Coorow
Coorow Holiday Program
Coorow Holiday Program
*
When: Tuesday 13th and Wednesday 14th March 2021
Time: 8:30am - 3pm, both days
Where: Coorow Primary School
Who: For students in years 1-6
Price: $10 per day
What to Bring: A packed recess snack, a drink bottle, & a spare change of clothes (in the unlikely event of getting muddied on the excursion)
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Medical Information
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*
Special Dietary Requirements
*
Does your child have any food allergies or special dietary requirements that SU should be aware of?
No
Yes
Please provide details of food allergies/special dietary requirements
*
Additional Participant Information
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Are there any family, behavioural, mental health or medical conditions which require special attention we should know about? E.g. hearing or sight or other impairment, ADD or ADHD, court order or custody issues, formal counseling situations, or any other?
No
Yes
Please Provide Details
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Emergency Contact Name
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Must be different to the primary contact provided above
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Agreement with SU WA
Parent / Guardian Agreement
*
SU WA is a ChildSafe organisation and this holiday program will operate under those principles.
I will drop off and pick up my child at the start and end of each program day, unless other arrangements have been made.
I understand that the first day of the program is an excursion and give permission for my child to travel on the bus.
I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.
I understand that the program leaders will take all responsible care of my child and that SU WA or its representatives will not be liable in any injury or accident, or for damage or loss of property.
I agree with these conditions for sending my child on a Scripture Union WA program.
Photo Consent
*
Do you consent to appropriate use by SU WA of photographs taken on the program that include your child?
Choose an answer
Yes
No
Payment
Total
$ 0.00
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Please use the details below to transfer your payment.
Name: Scripture Union WA
BSB: 036-044
Acc No: 106215
Reference: Coorow [+ child's name]
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