Tikipunga After School Care Application Form

How many children would you like to register?

Child 1 - First Name

Child 1 - Last Name

Child 2 - First Name

Child 2 - Last Name

Child 3 - First Name

Child 3 - Last Name

Child 4 - First Name

Child 4 - Last Name

Your Email

Your Address

Home Address

Contacts - People Authorized to Collect Your Children

How Many Authorised Parents or Caregivers

First Name

Last Name

Phone Number Authorised Caregiver 1

First Name 2

Last Name 2

Phone Number Authorised Caregiver 2

First Name 3

Last Name 3

Phone Number Authorised Caregiver 3

First Name 4

Last Name 4

Phone Number Authorised Caregiver 4

Please note, we are legally required to have two emergency contacts on file.

Emergency Contact 1

Emergency Contact 2

Doctor

Is there anything else we should know about in order to take good care of your child/children?

Start Date:

Privacy Act 1993: The information that you have provided is necessary for the safe and effective operation of the programme and will be used for the sole purpose of emergencies, birthdays and health and safety of the children as set out in the Policies and Procedures. If you have any questions regarding the programme, Complaints, Code of Behaviour and/or the Prevention of Child Abuse Policies etc please refer to the Programmes Policies and Procedures, which are available upon request.

All information about individuals is available to them for review at any time. As the monitoring agency for OSCAR services, Child Youth and Family may require access to this enrolment information

Medical Permissions

I give permission for staff to administer first aid and to seek emergency treatment if necessary.

Contract Agreement

I have read and agree with the Kidzone Contract.

Click here to read the Kidzone Contract

Holiday Programmes

After School Care

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