KIN nature playgroup enrolment form- term 2

KIN Nature Playgroup Enrolment and Consent Form
CHILD'S DETAILS
Select day for enrolment

Monday, Armstrong Creek- 9:30-11:30Tuesday, Torquay- 9:30-11:30
Name Parent Guardian #1

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Name Parent/ Guardian #2

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Childs name

First NameLast Name
Date of birth

MonthDayYear
Date
Home Address
Suburb
Post Code
Does your child have any special requirements. Does your child require any additional support due to a disability intellectual, or physical impairment. Are there any cultural, religious or dietary needs, medical conditions, or allergies/sensitivities

yesno
Description
Would you like to authorise another person to bring and participate with your child(ren)?

yesno
Name

First NameLast Name
Relationship/contact details
Would you like to list an alternative emergency contact person?

yesno
Name

First NameLast Name
Relationship/Contact details
Why did you choose our playgroup?

Interest in nature playRecommended by someoneAttended previouslyOther
CONSENT- ALL PROGRAMS
CHILD'S NAME
Type a question

I/We authorise the facilitator to use the photos/videos of my child for promotional purposes within marketing/advertising in print and on-line format.I/We authorise my child to participate in cooking and outdoor adventure activities within the program.I/ We acknowledge there are inherent risks involved in nature and outdoor activities and that due diligence will be followed to mitigate risks.
Parent / guardian signature

Clear
PROMOTIONS
HOW DID YOU HEAR ABOUT US

Surf Coast TimesInstagramFacebookWord of Mouth/ReferralOther
TERMS OF CONDITIONS

Thank you for joining KIN's Nature Playgroup.

1. Permission to receive first aid

I understand that participation in activities can expose the named participant to risk and possible injuries. I understand that there is a qualified First Aid attendant on site and hereby consent to receive medical treatment, including transportation to a doctor or hospital, which may be deemed advisable in the event of injury, accident and/or illness during this activity.

2. Appropriate clothing

I understand that it is my responsibility to ensure that my child is dressed appropriately for each activity and acknowledge that I have been briefed on the recommended attire.

3. Inclement and dangerous weather

Due to the location and nature of our activity sessions, the weather has the potential to impact participants' safety. I recognise that KIN SURF COAST reserves the right to cancel/implement alternative activities in the event of inclement and undesirable weather or other unforeseen circumstances.

4. Responsibility for personal possessions

I understand that I have the sole responsibility for my personal possessions before, during, and after the program. I also agree that KIN Surf Coast staff are not responsible for the theft of clothing or valuables during my child's involvement in this program.

5. Responsibility for child(ren)

I understand that I am solely responsible for the care and supervision of my child(ren) at all times during participation in the playgroup parent/child sessions.

6. Refunds and cancelations

I understand that KIN cannot refund any sessions that are missed due to absenteeism. Should KIN cancel due to weather or staffing, I will receive a credit for future programs.
Full Name
Date

MonthDayYear
Date
Signature

Clear
PRIVACY NOTIFICATION

The personal information requested on this form is being collected by KIN Surf Coast. The personal information will be used solely by KIN Surf Coast for that primary purpose or directly related purposes. The applicant understands that the personal information provided is for KIN Surf Coast and that they may apply to KIN Surf Coastfor access and/or amendment of the information.
Please note: Completed enrolment forms and payment is due before the first week of term.

Mondays- $160 (8-week term)

Tuesdays- $180 (9-week term)

You can pay by direct bank transfer:

Bank details:

Acc name: KIN Surf Coast Pty Ltd

BSB: 033 608

Account no: 248136

Or

Online

Click here

Please note, in an effort to create greater equity we wish to extend a reduced program rate to individual children who are from marginalised or single-parent families. In doing this we hope to promote equal opportunity and inclusion for all children who would benefit from play-based education. To access please email kinsurfcoast@gmail.com or contact Sarah on 0488 623 748.
Enrolment inquiries:

KIN Playgroup (KIN Surf Coast)

Sarah Bolus- 0488 623 748

Email: kinsurfcoast@gmail.com
Should be Empty:

KIN Nature Playgroup Enrolment and Consent Form

CONSENT- ALL PROGRAMS

PROMOTIONS