Gunditjmara January 2026 School Holiday Program Enrolment Form

Gunditjmara January 2026 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 9th of Janurary. 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.

PROGRAM SESSIONS

THURS 15TH
Geelong Trip - Bounce
8:30am to 5pm
Pick up & drop off at Harris Street Reserve

TUES 20TH
Harris Street Cultural Day
9am to 3pm
@ 64 Harris St (Harris Street Reserve) Warrnambool

THURS 22ND
Movie Day
Drop off @ 11:30am at McDonalds Central
Pick up @ Warrnambool Cinema about 3pm

Drop off and pickup times can depend on day. Please see program flyer for more information or contact Donna Chafield (infomation below)

Paper forms available at 24 Hopkins Road. For any questions regarding the program, please contact Donna Chatfield on 0418 392 417 or email donna.chatfield@gunditjmara.org.au.

FORMS MUST BE COMPLETED BY FRIDAY 9TH OF JANURARY
Do you or your child access our services at Gunditjmara Aboriginal Cooperative?*

YesNo

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 number*
Home phone number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency contact #1
Parent/Carer name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency contact #2
Parent/Carer name*

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

Street Address

Street Address Line 2

CityState / Province

Postal / Zip 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 First Name Last Name to attend the July 2025 Gunditjmara School Holiday Program.
Name*

First NameLast Name
Type a question*

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Gunditjmara January 2026 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: