Participant Enrolment Form 2023/2024

Participant Enrolment Form 2024

Face to Face, On-Lion & Craft/Education Pack Services
Child's Name*

First NameLast Name
Gender*
Date of Birth*

DayMonthYear
Who in the family is unwell?*
What is the person who is unwell status in the family i.e- child, Father, Mother etc*
Person who is being enrolled address*

Street Address

Street Address Line 2

CityState

Postcode
Primary Contact's Name*

First NameLast Name
Relationship to child*
eg. Mother, Father, Grandparent
Mobile Phone*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Postcode
Secondary Contact's Name*

First NameLast Name
Relationship to child*
eg. Mother, Father, Grandparent
Mobile Phone*
E-mail*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Postcode
Does your child have any ongoing medical conditions? *
(diabetes, asthma, epilepsy, cancer etc)
Whilst accessing our services, is your child required to take medication for this condition or any other conditions?*
Does your child have any allergies?*
(food, medicine, insects, etc)
Does your child have any special dietary requirements?*
For Playgroup/preschool and On-Lion sessions, does your child have any behavioral needs and/or concerns?*
For Playgroup/preschool sessions, is your child toilet trained?*
Lion Hearts Learning sometimes use images, videos and other marketing materials to promote what we do through different media forms including on social media. Do you consent for these to be published?*

YesNo
I understand that activities may be run off site and I give permission for the young person to be transported by staff/volunteers to the activity location if required.*

YesNo
I acknowledge that I have read and understand all the information provided about the applicable program/activity and agree that staff and volunteers shall be indemnified and kept indemnified from any injury, loss or damage whether to property or person whilst the young person is participating in the program of activity.*

YesNo
I understand that this consent will remain valid for 24 months from date of signature (unless withdrawn by you prior).*

YesNo
I understand that my personal details will be added to the Lion Hearts Learning database - this is stored in a confidential place and will not be provided to any other organisation without your written consent.*

YesNo
I agree for my details, including email, to be included in a mailing list for future promotion of Lion Hearts Learning Activities.*

AgreeDisagree
Please tick which LHL Services you would like to access?
prevnext( X )
LHL Playgroup/Preschool Tuesday's 9:30am to 12:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at Aberfoyle Park Community Centre
$ Free Quantity



LHL Playgroup/Preschool Thursday's 9:30am to 12:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at Aberfoyle Park Community Centre
$ Free Quantity



LHL Playgroup/Preschool Friday's 9:30am to 12:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at LHL Southern Branch, Roxanne Ave, Aberfoyle Park
$ Free Quantity



LHL Craft and Education Pack Service (activity packs posted fortnightly for ages 1.5yrs to all primary school ages but also flexible for early high school years)
$ Free Quantity



LHL 'On Lion' Service (Online learning for ages 1.5yrs to all primary school ages but also flexible for early high school years)
$ Free Quantity



Total

$0.00
By signing and submitting this enrolment form, you are confirming that the information provided by you is true and correct.
Parent/Guardian Signature*

First NameLast Name
Today's Date*

DayMonthYear
Date
Signature*

Clear
Should be Empty:

Participant Enrolment Form 2024