Holiday Program Enrollment Form - Top End Multi Sports

Details

Child 1:*

Date of Birth*

Child 2 (if applicable):

Date of Birth

Child 3 (if applicable):

Date of Birth

Address*

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

Medical Information

Medical Condition - Please Specify

Other Medical Information*

TERM 3 School Holiday Program (MID-YEAR)*

ADDITIONS TO OUR PROGRAM

How did you hear about our Program?

Approximate Drop Off Time

Approximate Pick up Time

PERMISSION TO USE PHOTOS

I 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 photos

I grant permission for the use of photos of myself and my children to be used
I 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.

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