SPRING HOLIDAY PROGRAM Booking Form

SPRING HOLIDAY PROGRAM BOOKING FORM

(please complete one form per family)
Child 1 - Name*

First NameLast Name
Child 1 - DOB*
example; 01/01/2000
Child 1 - Medical Notes - If yes please list*
Child 2 - Full Name

First NameLast Name
Child 2 - DOB
example; 01/01/2000
Child 2 - Medical Notes - If yes please list
Child 3 - Full Name

First NameLast Name
Child 3 - DOB
example; 01/01/2000
Child 3 - Medical Notes - If yes please list
Parent/ Guardian Name*

First NameLast Name
Mobile Contact Number*
Email*
Address*

example: 5 Whipple St Balcatta 6021

Street Address Line 2

SuburbState / Province

Post Code
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*
PERMISSION TO CALL AMBULANCE IN CASE OF EMERGENCY*

YES, I give permission for an ambulance to be calledNO, I do not give permission for an ambulance to be called
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 YES or NO if you agree to your child taking part.*

YES, I give Photo PermissionNO, I do not give Photo Permission
SPECIAL NOTE: 4year olds can ONLY attend the AM HALF DAY SESSION - 8am to 11am

Bookings for 4year olds will NOT be accepted for any other times!

WEEK ONE

	AM HALF DAY	FULL DAY (NO 4YR OLDS)	FULL DAY + EXTENDED PLAY (NO 4YR OLDS)	PM HALF DAY (NO 4YR OLDS)	PM + EXTENDED PLAY (NO 4YR OLDS)
TUESDAY 30TH SEPTEMBER
WEDNESDAY 1ST OCTOBER
THURSDAY 2ND OCTOBER
FRIDAY 3RD OCTOBER

SPECIAL NOTE: 4year olds can ONLY attend the AM HALF DAY SESSION - 8am to 11am

Bookings for 4year olds will NOT be accepted for any other times!

WEEK TWO

	AM HALF DAY	FULL DAY (NO 4YR OLDS)	FULL DAY + EXTENDED PLAY (NO 4YR OLDS)	PM HALF DAY (NO 4YR OLDS)	PM + EXTENDED PLAY (NO 4YR OLDS)
MONDAY 6TH OCTOBER
TUESDAY 7TH OCTOBER
WEDNESDAY 8TH OCTOBER
THURSDAY 9TH OCTOBER
FRIDAY 10TH OCTOBER

PRICING

	QUANTITY	TOTAL PRICE
AM HALF DAY (4 to 12 Years old) $60 per child
FULL DAY (5 to 12 Years old) $90 per child
FULL DAY + EXTENDED PLAY (5 to 12 Years old) $100 per child
PM HALF DAY(5 to 12 Years old) $60 per child
PM + EXTENDED PLAY(5 to 12 Years old) $70 per child
HALF DAY UPGRADE TO FULL DAY + EXTENDED PLAY(5 to 12 Years old) $15 per child
5 DAY BOOKINGS PLEASE CONTACT RECEPTION

SPRING HOLIDAY PROGRAM BOOKING FORM