Wild School Programme Enrolment

Wild School Programme Enrolment

Enrolment Form for Our One Day Wild School/School Holiday Programmes - 5- 12 year olds
Which programme do you wish to enrol in?*
Child's Name*

First NameLast Name
Age*
Birth Date*

MonthDayYear
Date
School*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 *

First NameLast Name
Mobile Phone Number*

Area CodePhone Number
Other Contact Phone

Area CodePhone Number
Email*
example@example.com
Parent/Guardian 2 *

First NameLast Name
Mobile Phone Number*

Area CodePhone Number
Other Contact Phone

Area CodePhone Number
Email*
example@example.com
Emergency Contact (Additional to Parents, If we can't get in touch with you) *

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to family*
Other people who can collect your child
Please include full names & relationship to family
Other people who cannot collect your child
Please include full names & relationship to family
What strengths, interests and hobbies does your child have?
Does your child have any allergies or health needs that we should know about? Please describe
Does your child need support with: (select any/all that apply)

Self-managementSocial interactionsSelf-esteemResilienceAnxietyManaging feelingsSocial problem solvingMaking friendsRisk takingConfidenceCreativity & imaginationCommunication & LanguageOther
If you selected "other" please describe
Does your child have any learning or behaviour needs that we should know about? Please describe
What are the reasons you would like your child to attend Wild School?*
How did you hear about us?*
Please read the following pages for details around participation, terms and conditions*

I consent to my child participating in the selected Wild School programmeI consent to the Wild School Terms and Conditions
Photo/Video Consent*

I consent to my child featuring in photos and/or video that may be used on our Facebook, Instagram and/or website.I do not consent to my child featuring in photos and/or video that may be used on our Facebook, Instagram and/or website
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Parent/Guardian Signature *

Clear
Privacy Act 2020: The information you have supplied is necessary for the safe and efficient operation of WS. All personal information is held confidentially, and not shared with another party. You are welcome to review information held on your child at any time.
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