Clone of Shipwrecked 2025 Registration

Holiday Programme Registration
Child's Name

First NameLast Name
Birth Date

DayMonthYear
Year Level
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Format: (000) 000-0000.
Cell Number
Format: (000) 000-0000.
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Format: (000) 000-0000.
Alternative Phone Number
Format: (000) 000-0000.
Does the child have any dietary requirements or allergies? If yes, please explain any instructions.
Does the child have any behavioural or other needs? If yes, please explain.
Which day/days would you to register for? Tick as required.
I understand that Harvestfield Church is committing to the welfare and safety of children and young people and while in attendance at the Harvestfield Church Holiday Programme, my child/children will be expected to abide by the Harvestfield Church Behaviour Policy. Should the behaviour of my child become problematic during the course of the programme, I may be contacted and requested to collect and/or manage my child/children’s behaviour.
Once registered, an email will be sent to the address provided above regarding payment options.
Should be Empty:

Holiday Programme Registration