Clone of LHL Participant Enrolment Form 2024 2025

Child's Name

First NameLast Name

Gender

Date of Birth

DayMonthYear

Who in the family is unwell?

What is the person who is unwell status in the family i.e- child, Father, Mother etc

Person who is being enrolled home address

Street Address

Street Address Line 2

CityState

Postcode

Primary Contact's Name

First NameLast Name

Relationship to child

eg. Mother, Father, Grandparent

Mobile Phone

Format: 0400000000.

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState

Postcode

Secondary Contact's Name

First NameLast Name

Relationship to child

eg. Mother, Father, Grandparent

Mobile Phone

Format: 0400000000.

E-mail

example@example.com

Address

Street Address

Street Address Line 2

CityState

Postcode

Does your child have any ongoing medical conditions?

(diabetes, asthma, epilepsy, cancer etc)

Whilst accessing our services, is your child required to take medication for this condition or any other conditions?

Does your child have any allergies?

(food, medicine, insects, etc)

Does your child have any special dietary requirements?

For LHL Play and Learn Playgroup and On-Lion sessions, does your child have any behavioral needs and/or concerns?

For LHL Play and Learn Playgroup sessions, is your child toilet trained?

Lion Hearts Learning sometimes use images, videos and other marketing materials to promote what we do through different media forms including on social media. Do you consent for these to be published?

I understand that activities may be run off site and I give permission for the young person to be transported by staff/volunteers to the activity location if required.

I acknowledge that I have read and understand all the information provided about the applicable program/activity and agree that staff and volunteers shall be indemnified and kept indemnified from any injury, loss or damage whether to property or person whilst the young person is participating in the program of activity.

I understand that this consent will remain valid for 24 months from date of signature (unless withdrawn by you prior).

I understand that my personal details will be added to the Lion Hearts Learning database - this is stored in a confidential place and will not be provided to any other organisation without your written consent.

I agree for my details, including email, to be included in a mailing list for future promotion of Lion Hearts Learning Activities.

Please tick which LHL Services you would like to access?

LHL Play and Learn Playgroup Tuesday's 9:30am to 12:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at Aberfoyle Park Community Centre

Free Quantity

LHL Play and Learn Playgroup Thursday's 9:30am to 12:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at Aberfoyle Park Community Centre

Free Quantity

LHL Play and Learn Playgroup Friday's 9:30am to 12:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at LHL Southern Branch, Roxanne Ave, Aberfoyle Park

Free Quantity

LHL Craft and Education Pack Service (activity packs posted fortnightly for ages 1.5yrs to all primary school ages but also flexible for early high school years)

Free Quantity

LHL 'On Lion' Service (Online learning for ages 1.5yrs to all primary school ages but also flexible for early high school years)

Free Quantity

LHL Play and Learn Playgroup Tuesdays 10:30am to 1:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at LHL Northern Branch, Leukeamia Foundation, Lightsview

Free Quantity

LHL Play and Learn Playgroup Fridays 10:30am to 1:30pm for ages - child must be crawling to 5yrs but flexible for early primary years at LHL Northern Branch, Leukeamia Foundation, Lightsview

Free Quantity

Total

By signing and submitting this enrolment form, you are confirming that the information provided by you is true and correct.

Parent/Guardian Signature

First NameLast Name

Today's Date

Date

Signature

Participant Enrolment Form 2026

Please tick which LHL Services you would like to access?