Holiday Program Enrollment Form ; DetailsChild 1 First Name* Child 1 Last Name* Date of Birth* Gender*GenderMaleFemaleChild 2 First Name (if applicable): Child 2 Last Name (if applicable): Date of Birth GenderGenderMaleFemaleChild 3 First Name (if applicable): Child 3 Last Name (if applicable): Date of Birth GenderGenderMaleFemaleAddress* Suburb* Post Code* Email Address* Person to be contacted*Emergency Contact No.*Second Emergency Contact No.* 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. I grant permission for the use of photos of myself and my children to be used. 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. Location: 110 Old McMillans Rd, Coconut Grove Cost for Holiday Program: $75 per day or $300 for the full week (Must be 5 days in the same week) Medical InformationMedical Condition - Please Specify* Child 2 Child 3 Other Medical Information* Mid Year School Holiday Program* Deselect All Monday 4th of July Tuesday 5th of July Wednesday 6th of July Thursday 7th of July Friday 8th of July Monday 11th of July Tuesday 12th of July Wednesday 13th of July Thursday 14th of July Friday 15th of July How did you hear about our Program? School newsletter Facebook/Instagram Have been before Friends Other Approximate Drop Off Time 8 am Approximate Pick up Time 4 pm Read Terms of Site* I have read and understood the terms of this site. CAPTCHA