Gunditjmara April 2026 School Holiday Program Enrolment Form

Gunditjmara April 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 Monday 6th of April. 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

WED 8TH
Werribee Open Range Zoo
Bus leaving Harris Street @ 8am
Bus returningto Harris Street @ 5pm

Paper forms available at 24 Hopkins Road. For any questions regarding the program, please Sam Delany on 0487 595 410 or email samantha.delany@gunditjmara.org.au

FORMS MUST BE COMPLETED BY MONDAY 6TH OF APRIL
YesNo

Werribee Open Range Zoo - Wednesday 8th of April
Child Details
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Age*
MaleFemaleOther
AboriginalTorres Strait Islander
School name*
School address*
YesNo
If yes, please provide further information

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
YesNo
Please list below if there are any services/programs at Gunditjmara you would like to know more about (if any)
YesNo
YesNo
Photo/video consent
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
Signature*
Date*

MonthDayYear
Date
Should be Empty:

Gunditjmara April 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: