Gunditjmara 2023 September School Holiday Enrolment Form

Gunditjmara July School Holiday Program Enrolment form
Ngatta and welcome to the online Gunditjmara School Holiday program enrolment form.

Please fill out all of the details below and click 'submit' at the end of this form.

All children participating in this program must be of primary school age (5-12 years old).

Forms MUST be submitted by Friday 11th July. If you are enrolling more than one child in the program, you must fill out multiple forms.

Parents/cares are responsible for dropping off and picking up children at the indicated times and locations. Please call Gunditjmara if a later pickup time needs to be arranged.

If your child becomes sick or is unwell, we expect the parent/carer/emergency contact to collect child in reasonable time frame. If children are to be picked up by other people, we need written/verbal permission by parent/carer.

If your child has any additional needs filled out on the form, you will be contacted for a management plan if one has not been sent.

DATE(S): Thursday 17th of July 2025

LOCATION: Warrnambool Capitol Cinema

Drop off: 11:30am @ McDonalds Central for Lunch
After lunch, we’ll walk up to the movies together

Pick up: Warrnambool Capital Cinema (54 Kepler St, Warrnambool VIC 3280) @ 3pm

Drop off and pickup times depend on day. Please see program flyer for more information.

Paper forms available at 24 Hopkins Road. For any questions regarding the program, please contact Donna Chatfield on 5559 1234 or email donna.chatfield@gunditjmara.org.au.

FORMS MUST BE COMPLETED BY FRIDAY 11TH JULY.
Do you or your child access our services at Gunditjmara Aboriginal Cooperative?*

YesNo
This program is only available to Community who access our services. For any questions, please contact Donna Chatfield on 5559 1234.

Dietary requirements:
Children’s lunch/snacks will be organised prior to the activities. Please notify us of any special dietary needs your child has (favourite/disliked foods, allergies, vegan, vegetarian, celiac, lactose intolerant etc).
Family details:
Parent/Carer name:*

First NameLast Name
Relationship to child:*
Mobile phone number:*
Home phone number:
Address*

Street Address

Street Address Line 2

CityState

Post Code

Emergency Contact #1
Emergency Contact Name*

First NameLast Name
Relationship to child:*
Mobile phone number:*
Home phone number:
Address*

Street Address

Street Address Line 2

CityState

Post Code
Emergency Contact #2
Emergency Contact Name*

First NameLast Name
Relationship to child:*
Mobile phone number:*
Home phone number:
Address*

Street Address

Street Address Line 2

CityState

Post Code

Last few questions:
Are you aware of other services available at Gunditjmara?:*

YesNo
Please list below if there are any services/programs at Gunditjmara you would like to know more about (if any):
Do you need help with any of the above or have any questions? If yes, we will contact you.*

YesNo
Do you give permission to take the child on excursions from Harris Street Reserve:*

YesNo
Photo/video consent
I understand that it will not be for recording purposes only and may be reproduced in future publications.*

YesNo

Final sign off:
Participant’s behaviour
‘I understand that in the event of my child’s misbehaviour or behaviour that poses a danger to themselves or others during the excursion or during the school holiday program, they may be sent home. I further understand that in such circumstances I will be informed and that any costs associated with their return may be my responsibility.’

Participant illness
‘I understand that in the event excursion staff determine it is necessary for my child to be sent home early due to illness, any cost associated with their return may be my responsibility.’

Cancellations or Alterations
‘I understand that GAC may need to cancel or alter excursion arrangements at short notice, for safety reasons or due to circumstances beyond the control of GAC, and while the Event Organiser will try to minimise inconvenience or financial losses to parents, these may be unavoidable.’

Accident insurance and ambulance cover
GAC does not provide accident insurance or ambulance cover. Parents may wish to obtain accident insurance from a commercial insurer and/or ambulance cover, depending on their health insurance arrangements and any other personal considerations.

Parent/Carer consent
I have read all the above information provided by GAC in relation to the school holiday program excursions and programs, including any attached material.

Your personal records are treated with the strictest confidentiality and the information provided will not be shared without your consent.
Please name and sign to confirm that you understand and agree with the information provided on this form:
I give permission for (child's name)* to attend the July 2025 Gunditjmara School Holiday Program.
Parent/Carer name:*

First NameLast Name
Parent/Carer signature:*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Gunditjmara July School Holiday Program Enrolment form

Child Details

Health details:

Dietary requirements:

Family details:

Emergency Contact #1

Emergency Contact #2

Last few questions:

Photo/video consent

Final sign off:

Please name and sign to confirm that you understand and agree with the information provided on this form: