WINTER HOLIDAY PROGRAM BOOKING FORM

WINTER HOLIDAY PROGRAM BOOKING FORM

4yrs to 12yrs (4yrs AM Half Day Only)
The following days are Fully Booked

Monday 4th July
CHILD 1 - DETAILS *

First Name Last Name
DOB *
MEDICAL NOTES - CHILD 1 (if yes please list)
CHILD 2 - DETAILS

First Name Last Name
DOB
MEDICAL NOTES - CHILD 2 (if yes please list)
CHILD 3 - DETAILS

First Name Last Name
DOB
MEDICAL NOTES - CHILD 3 (if yes please list)
PERMISSION TO CALL AN AMBULANCE IN CASE OF EMRGENCY *

YES, I give permission to call an ambulance NO, I do not give permission to call an ambulance
PHOTO PERMISSION - During the Holiday Program children may be photographed/ videoed for future promotional use by NDGC on printed material, social media and/or website. Please tick Y or N if you agree to your child taking part. *

YES, I give permission for my child to be photographed/ videoed NO, I do not give permission for my child to be photographed/ videoed
PARENT/ GUARDIAN DETAILS *

First Name Last Name
Contact Number *
EMAIL *
ADDRESS *

Street Address

Street Address Line 2

Suburb State

Post Code
EMERGENCY CONTACT (must be different to above) *

First Name Last Name
Contact Number *

WEEK 1 - click on the day/s you would like to attend

	FULL DAY 8AM - 3PM	FULL DAY + EXTENDED PLAY 8AM - 4.30PM	PM HALF DAY 12PM - 3PM	PM HALF DAY + EXTENDED PLAY 12PM - 4.30PM	AM HALF DAY 8AM - 11AM
TUESDAY 5TH JULY
WEDNESDAY 6TH JULY
THURSDAY 7TH JULY
FRIDAY 8TH JULY

WEEK 2 - click on the day/s you would like to attend

	FULL DAY 8AM - 3PM	FULL DAY + EXTENDED PLAY 8AM - 4.30PM	PM HALF DAY 12PM - 3PM	PM HALF DAY + EXTENDED PLAY 12PM - 4.30PM	AM HALF DAY 8AM - 11AM
MONDAY 11TH JULY
TUESDAY 12TH JULY
WEDNESDAY 13TH JULY
THURSDAY 14TH JULY
FRIDAY 15TH JULY

PRICES

	QUANTITY	TOTAL
FULL DAY - $65.00 (per child)
FULL DAY + EXTENDED PLAY - $75 (per child)
AM OR PM HALF DAY - $50 (per child)
HALF DAY UPGRADE TO FULL DAY +5YRS ONLY $15 extra
PM HALF DAY ONLY + EXTENDED PLAY $60 (per child)
3 DAYS - $180
3 DAYS + EXTENDED PLAY - $210
4 DAYS - $230
4 DAYS + EXTENDED PLAY - $270
5 DAYS - $280
5 DAYS + EXTENDED PLAY - $330

REFUNDS

Please ensure when you book and pay the dates booked are true and correct. We DO NOT offer refunds or transfers on our programs once payment has been processed.
Should be Empty: