School Holiday Program Registration Form
Amana Community Services is excited to have you join our Holiday Program. Please complete this registration form, and our team will be in touch within 24hours to confirm your booking.
Confidentiality Disclaimer:
All information collected in this registration form is strictly confidential and will only be used for the purpose of delivering and supporting participation in the School Holiday Program. Your details will not be shared with any third party without your consent, except where required by law.
Are you completing this registration form for yourself or on behalf of someone else:
*
For Myself
On Behalf of Someone
Child Details:
Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/ Guardian Name:
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
Emergency Contact Details
*
Full Name
Contact Number
Primary Contact
Secondary Contact
Mode of Communication:
*
Language Spoken:
Preferred Method of Communication:
Please Select
Face to Face
Phone Call
Text Message
Email
Letter
Medical Details:
Allergies:
*
Dietary Requirements:
*
Medications:
*
Back
Next
Program Detail:
How many days would you like to attend?
*
Monday (Board Games & Nerf War)
Tuesday (Movie Making Competition)
Wednesday (Movie Making Competition & other activities)
Thursday (Card Games, Legos & Water Fight)
Friday (Bowling, Laser Tag & Arcade)
Do you require transport services?
*
Yes
No
Additional Notes/ Queries:
Agreement
By signing this form, I acknowledge and agree to Amana Community Services’ cancellation policy. Cancellations must be made at least 48 hours prior to the scheduled program. If I fail to provide notice within this timeframe, I understand that I will be charged the full program fee.
I give consent for Amana Community Services to take photos of my child for the purpose of sharing updates with parents during the program, as well as for use in promotional and advertising materials.
*
Yes, I provide consent.
No, I do not provide consent.
Participant/ Guardian Signature:
*
Date
*
-
Month
-
Day
Year
Payment Details
- Please select the number of days your child would like to attend under quantity. Please select the bus quantity according to the number of days you select for the holiday program.
My Products
prev
next
( X )
Holiday Program (one-day)
This is the fee for ONE DAY of the program excluding bus fees.
$
40.00
AUD
Quantity
1
2
3
4
5
Bus Fees
Bus fees per day. Please select quantity according to the number of days the bus service is needed.
$
5.00
AUD
Quantity
1
2
3
4
5
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Continue
Continue
Should be Empty: