KARI Cultural Vacation Care Registration form

KARI Cultural Unit Vacation Care

Registration form
Where will you drop off/pick up your child?
How many Children/Young People are you registering today?
YOU CAN REGISTER UP TO SIX YOUNG PEOPLE ON THIS FORM. IMPORTANT !! Please ensure you complete ALL DETAILS for EACH YOUNG PERSON, to ensure there is a place for them on the camp.
Carer Information
Carers Name

First NameLast Name
Carers Address

Street Address

SuburbState

Post Code
Carers Mobile Number

Area CodePhone Number
Carers E-mail
Child/Young Persons Information 1
Child / Young Persons Name

First NameLast Name
Child / Young Persons Date of Birth

DayMonthYear
Child / Young Persons Gender
Does your child/young person have a history of any of the following?

Other
Please give details
Child/Young Persons Information 2
Child / Young Persons Name

First NameLast Name
Child / Young Persons Date of Birth

DayMonthYear
Child / Young Persons Gender
Does your child/young person have a history of any of the following?

Other
Please give details
Child/Young Persons Information 3
Child / Young Persons Name

First NameLast Name
Child / Young Persons Date of Birth

DayMonthYear
Child / Young Persons Gender
Does your child/young person have a history of any of the following?

Other
Please give details
Child/Young Persons Information 4
Child / Young Persons Name

First NameLast Name
Child / Young Persons Date of Birth

DayMonthYear
Child / Young Persons Gender
Does your child/young person have a history of any of the following?

Other
Please give details
Child/Young Persons Information 5
Child / Young Persons Name

First NameLast Name
Child / Young Persons Date of Birth

DayMonthYear
Child / Young Persons Gender
Does your child/young person have a history of any of the following?

Other
Please give details
Child/Young Persons Information 6
Child / Young Persons Name

First NameLast Name
Child / Young Persons Date of Birth

DayMonthYear
Child / Young Persons Gender
Does your child/young person have a history of any of the following?

Other
Please give details
I understand this form is registration only. KARI Staff will be in contact once registrations are completed and places have been allocated
My child/young person, identifies as Aboriginal and is currently in OOHC
Should be Empty:

KARI Cultural Unit Vacation Care