2.0 2025 Spring WILD SCHOOL (5-12 year olds) Holiday Programme Enrolment

Holiday Programme Enrolment

Enrolment Form for Wild School Holiday Programmes - 5- 12 year olds - $75 per day
Child's Name*

First NameLast Name
Age*
Birth Date*

DayMonthYear
Date
Please select the dates you would like to enrol for. NOTE: This is for Wild School, 5-12 year olds only, Wild Kindy 3-6 year olds will need to enrol on a seperate form. You will need to complete one form per child - Thank you :-) *
What strengths, interests and hobbies does your child have?
Does your child have any allergies or health needs that we should know about? Please describe. If none please write N/A*
Does your child need support with: (select any/all that apply)

Self-managementSocial interactionsSelf-esteemResilienceAnxietyManaging feelingsSocial problem solvingMaking friendsRisk takingConfidenceCreativity & imaginationCommunication & LanguageOther
If you selected "other" please describe
Does your child/ren have any learning or behaviour needs that we should know about? Please describe
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1 *

First NameLast Name
Mobile Phone Number*

Area CodePhone Number
Other Contact Phone

Area CodePhone Number
Email*
example@example.com
Parent/Guardian 2 *

First NameLast Name
Mobile Phone Number*

Area CodePhone Number
Other Contact Phone

Area CodePhone Number
Email*
example@example.com
Emergency Contact (Additional to Parents, If we can't get in touch with you. This person will be responsible for making decisions for your child and/or collecting if required) *

First NameLast Name
Phone Number*

Area CodePhone Number
Relationship to family*
Other people who can collect your child/ren
Please include full names & relationship to family
Other people who cannot collect your child/ren
Please include full names & relationship to family
What are the reasons you would like your child/ren to attend Wild School?*
How did you hear about us?*
Please read the following pages for details around participation, terms and conditions*

I consent to my child participating in the selected Wild School programmeI consent to the Wild School Terms and Conditions
Photo/Video Consent*

I consent to my child featuring in photos and/or video that may be used on our Facebook, Instagram and/or websiteI do not consent to my child featuring in photos and/or video that may be used on our Facebook, Instagram and/or website
Parent/Guardian Name*

First NameLast Name
Date*

MonthDayYear
Date
Parent/Guardian Signature *

Clear
Privacy Act 2020: The information you have supplied is necessary for the safe and efficient operation of WS. All personal information is held confidentially, and not shared with another party. You are welcome to review information held on your child at any time.
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