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Kids Club Registration

Registration is OPEN for our annual July school holiday Kids Club event! Kids K-6 are invited to attend this super fun Space themed holiday activity for just $5/day.

Program Dates: 18-20 July

Theme: Lost in Space

Place: 9 Littleton Street, Riverwood.

REGISTRATION FORM - KIDS CLUB 2018

Child Details
Child's Name*
First Last
Address*
Date of Birth*
Sex*
- Male
- Female
School Attended*
School Year*
Parent/Carer Details
Parent/Carer Name*
First Last
Contact Number*
Parent/Carer Email
Health Information
Emergency Contact Name*
First Last
Other than Parent
Emergency Contact Phone Number
Family Dr Name*
Family Dr Phone Number*
Medicare Number*
Medicare Number Expiry*
Health Insurer
(if applicable)
Health Insurer Membership Number
(if applicable)
Date of Last Tetanus Booster*
Detail any allergies
Reaction to allergen
Any current medication
Please place any medications in a container with child’s name and dosage details clearly marked on lid and give to First-Aid Office on arrival.
Does the child have any disability that may restrict their ability in any activity?
Does this child suffer from any serious illness?
Does the child have any special dietary requirements?
Further Details
What Days will your child be attending?
- Wednesday
- Thursday
- Friday
My Child would like to be with this friend/family member during the activities
Name of person collecting child/relationship to the child
Photography Consent*
- Yes
- No
Photos/Videos of my child may be used for Riverwood/Punchbowl Anglican Church promotional purposes on our Facebook page and website.
Are you interested in your child attending a regular weekly (school term) after school club at Riverwood Anglican Church?

Kids Club Registration

REGISTRATION FORM - KIDS CLUB 2018

Child Details

Parent/Carer Details

Health Information

Further Details

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