Holiday Program Enrollment Form ; DetailsChild 1:*Date of Birth*Child 2 (if applicable):Date of BirthChild 3 (if applicable):Date of BirthAddress*Email Address* Person to be contacted*Emergency Contact No.*Booking Contact Name I, the above mentioned name, give consent for my child to participate in the TEMS Holiday Programas programmed and conducted by Ben McLachlan and any other employees/contractors of TEMS. I authorize Ben McLachlan and any assistant trainers of TEMS to obtain any medical assistance, which they may deem necessary should an accident occur, and agree to pay all medical expenses incurred. I submit the attached medical information about my child and include other relevant information and details of limitations. I further authorize qualified practitioners to administer anesthetic if such an eventuality arises. I agree to a cancellation fee of $35 if less than 6hours’ notice is given and 100% of fee if less than 2 hours’ notice is given. I agree that payment will be made in full prior to my child beginning the above mentioned program. Location: 110 Old McMillans Rd, Coconut Grove Cost for Holiday Program: $60 per day or $250 per week Cost for Essington Holiday Program: $50 per dayMedical InformationMedical Condition - Please SpecifyOther Medical Information*School Holiday Program (20th January - 24th January) Monday 20th January Tuesday 21st January Wednesday 22nd January Thursday 23rd January Friday 24th January How did you hear about our Program? School newsletter Facebook/Instagram Have been before Friends Other Approximate Drop Off TimeApproximate Pick up TimePERMISSION TO USE PHOTOSI grant permission to TEMS to use images of:Parent's Name*Children's Name*Name of person providing permission to use photos*Such use includes the display, distributions, publications, transmissions or otherwise use of photographs, images and/or videos taken for use in materials that include but may not be limited to, printed materials such as Brochures, Newsletters, Videos and digital images used on TEMS’ website and other Social Media pages, such as Facebook and Instagram.Permission Grant for photosI grant permission for the use of photos of myself and my children to be usedI deny permission for the use of photos of myself and my children to be used**Please notify TEMS in writing if you would like to withdraw your permission for the use of images.Read Terms of Site* I have read and understood the terms of this site. CAPTCHA This iframe contains the logic required to handle Ajax powered Gravity Forms.
