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      <p>IF BOOKED OUT PLEASE EMAIL <a href="mailto:youth@chabad.com.au?subject=HP%20Waiting%20List">YOUTH@CHABAD.COM.AU </a>WITH YOUR CHILDS NAME AND DATES REQUIRED SO YOU CAN BE ADDED TO THE WAITING LIST</p>
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<div class="form-group" style="text-align: left;">
<span style="font-weight: 700; text-align: left;">Child</span><span style="font-weight: 700; text-align: left;"> First Name*</span></div>
<div class="form-group">
<input class="form-control" data-parsley-group="block1" id="child-firstname" name="child-firstname" placeholder="First Name" required="" type="text"></div>
</div>
<div class="col-sm-6 col-xs-12">
<div class="form-group"> <span style="font-family: Muli, sans-serif; font-weight: 700;">Child                         Middle Name</span></div>
<div class="form-group">
<input class="form-control" data-parsley-group="block1" id="child-middlename" name="child-middlename" placeholder="Middle Name" type="text"></div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<label for="child-lastname">Child Last Name*</label><input class="form-control" data-parsley-group="block1" id="child-lastname" name="child-lastname" placeholder="Last Name" required="" type="text"></div>
<p>
<strong>Current Grade*</strong></p>
<select class="form-control" data-parsley-group="block1" id="Grade" name="Grade" required="">
<option>Prep</option>
<option>1</option>
<option>2</option>
<option>3</option>
<option>4</option>
<option>5</option>
<option>6</option>
</select></div>
<p> </p>
</div>
</div>
<div class="row">
<div class="col-sm-6 col-xs-12">
<div class="form-group">
<label for="parent1-firstname">Parent First Name*</label><input class="form-control" data-parsley-group="block1" id="parent1-firstname" name="parent1-firstname" placeholder="First Name" required="" type="text"></div>
</div>
<div class="col-sm-6 col-xs-12">
<div class="form-group">
<label for="parent1-middlename">Parent Middle Name</label><input class="form-control" id="parent1-middlename" name="parent1-middlename" placeholder="Middle Name" type="text"></div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<label for="parent1-lastname">Parent Last Name*</label><input class="form-control" data-parsley-group="block1" id="parent1-lastname" name="parent1-lastname" placeholder="Last Name" required="" type="text"></div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<label for="parent1-contact-number">Parent Contact Number*</label><input class="form-control" data-parsley-group="block1" id="parent1-contact-number" name="parent1-contact-number" placeholder="Number" required="" type="text"></div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<label for="parent1-email">Parent Email*</label><input class="form-control" data-parsley-group="block1" id="parent1-email" name="x_email" placeholder="Number" required="true" type="text"></div>
</div>
</div>
<div class="row">
<div class="col-sm-12"> 
<div class="checkbox">
<label><input data-parsley-group="block1" name="filled-enrollment-form" required="" type="checkbox" value="true">My child has attended the Chabad Malvern Holiday Program in 2024-25                         and has filled out the OWNA Child Information Form* <small>                                           <a href="https://forms.owna.com.au/enrol.aspx?c=chabadmalvernvc"> <strong>If not, please click here                                     to fill it out before continuing</strong></a><a href="/Article.asp?AID=2955158" target="_blank">                                                   <strong>.</strong></a></small></label></div>
<div>
<button id="select-all-days" type="button">All Days</button></div>
<div id="child-1-section"> </div>
</div>
</div>
<div id="child2" style="display: none;">
<div class="row">
<div class="col-sm-12">
<h4>
<strong>Child 2:</strong></h4>
</div>
<div class="col-sm-6 col-xs-12">
<div class="form-group">
<strong>
<label for="child2-firstname">Child 2 First Name*</label><input class="form-control child2-required" data-parsley-group="block2" id="child2-firstname" name="child2-firstname" placeholder="First Name" type="text"></strong></div>
</div>
<div class="col-sm-6 col-xs-12">
<div class="form-group">
<strong>
<label for="child2-middlename">Child 2 Middle Name</label><input class="form-control" data-parsley-group="block2" id="child2-middlename" name="child2-middlename" placeholder="Middle Name" type="text"></strong></div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<strong>
<label for="child2-lastname">Child 2 Last Name*</label><input class="form-control child2-required" data-parsley-group="block2" id="child2-lastname" name="child2-lastname" placeholder="Last Name" type="text"></strong></div>
<div class="checkbox">
<strong>
<label><input data-parsley-group="block2" name="filled-enrollment-form-child2" class="child2-required" type="checkbox" value="true">I have completed a Chabad                                 Malvern OWNA Child Information form for Child 2* <small>                                                                <a href="https://www.owna.com.au/enrol/chabadmalvernvc.html"> <strong>If not, please                                             click here to fill it out before continuing</strong></a><a href="/Article.asp?AID=2955158" target="_blank">                                                                       <strong>.</strong></a></small></label></strong></div>
</div>
</div>
<div class="row">
<div class="col-sm-12"><strong><button id="select-all-days-child2" type="button">All Days</button>                              </strong>
<div id="child-2-section"> </div>
</div>
</div>
</div>
<div class="row" id="button-remove-child" style="display: none;">
<div class="form-group text-center">
<strong>
<button class="btn btn-primary" id="remove-child" type="button">Remove Child</button></strong></div>
</div>
<div class="row" id="button-add-child">
<div class="col-sm-12">
<div class="form-group text-center">
<strong>
<strong><strong>
<strong><button class="btn btn-primary" id="add-child" type="button">Add                                         Child</button></strong></strong></strong></strong></div>
</div>
</div>
<div class="row">
<div class="col-sm-12">
<div class="form-group">
<strong>
<strong><strong>
<strong><label for="After care">If After Care required (4:30pm - 5:00pm for                                         $10 p/family) please enter details here:</label><input class="form-control" data-parsley-group="block1" id="After Care Details" name="After Care Details" type="text"></strong></strong></strong></strong></div>
</div>
</div>
<p>
<strong> </strong></p>
<div class="row">
<div class="col-sm-12"><br>
<strong>
<strong><strong>
<strong><b>
<span style="font-size: 10.5pt; line-height: 107%; font-family: Arial, sans-serif;">PAYMENT                                         INFORMATION: Bookings close 19th June or if places filled prior.  Price $110 a day (including catered lunch &amp; snacks) minus                                         eligible CCS rebate. </span></b></strong></strong></strong></strong><span style="font-weight: 700; font-family: Muli, sans-serif;">                               <span style="font-family: Arial, sans-serif; font-size: 10.5pt; line-height: 14.98px;">Cancellations after 19th June will still be charged full fees.</span></span><strong>                             <strong>                                        <strong>                                                <strong>                                                        <b>                                                             <span style="font-size: 10.5pt; line-height: 107%; font-family: Arial, sans-serif;"><br>
<br>
</span></b></strong></strong></strong></strong>
<div class="form-group"><br>
<strong>
<strong><strong>
<strong><label for="cc-name">Name on Credit Card*</label><input class="form-control" data-parsley-group="block1" id="cc-name" name="cc-name" required="" type="text"></strong></strong></strong></strong></div>
<div class="form-group">
<strong>
<strong><strong>
<strong><label for="cc-number">Credit Card Number*</label><input class="form-control" data-parsley-group="block1" id="cc-number" name="cc-number" required="" type="text"></strong></strong></strong></strong></div>
</div>
</div>
<p>
<strong> </strong></p>
<div class="row">
<div class="col-sm-6 col-xs-12">
<div class="form-group">
<strong>
<strong><strong>
<strong><label for="cc-expiry-month">Expiry*</label><br>
<select class="form-control" data-parsley-group="block1" id="cc-expire-month" name="cc-expire-month" required="" style="float: left;">
<option>January</option>
<option>February</option>
<option>March</option>
<option>April</option>
<option>May</option>
<option>June</option>
<option>July</option>
<option>August</option>
<option>September</option>
<option>October</option>
<option>November</option>
<option>December</option>
</select><select class="form-control" data-parsley-group="block1" id="cc-expire-year" name="cc-expire-year" required="">
<option>2023</option>
<option>2024</option>
<option>2025</option>
<option>2026</option>
<option>2027</option>
<option>2028</option>
<option>2029</option>
<option>2030</option>
<option>2031</option>
<option>2032</option>
<option>2033</option>
<option>2034</option>
</select></strong></strong></strong></strong></div>
</div>
<div class="col-sm-6 col-xs-12">
<div class="form-group">
<strong>
<strong><strong>
<strong><label for="cc-cvv">CVV*</label><input class="form-control" data-parsley-group="block1" id="cc-cvv" name="cc-cvv" required="" type="text"></strong></strong></strong></strong></div>
</div>
</div>
<p>
<strong> <u>                            <strong>EXCURSION PERMISSION FORM</strong></u></strong></p>
<div class="row">
<div class="col-sm-12"><strong>
<strong><strong>
<strong>Our Excursions during vacation care are for children to develop an                                 understanding of belonging to groups and communities and to learn to interact in                                 relation to others with care, empathy and respect.<br>
<br>
Transportation Details (to and from): The most convenient and safest route as determined                                 by the bus driver at the time. All children will be on bus equipped with seatbelts.                                 Staff to child ratio: Will be a minimum of 1:15 The Period the Child will be Away from                                 the Service Premises and Leaving and returning times are specified for each excursion above. Please note the approximate number of expected children is 59. Our Diploma Qualified                                 Educators are Menucha Cooper, Reuvi Cooper, Lola Digaletos, Mushka Lider who will be together with Nicolle Aldana, Zahava Welis and 8 volunteers.</strong></strong></strong></strong>
<h5>
<strong>
<strong><strong>
<strong><strong>Authority for my Child in Program to Attend the                                         Excursion:</strong></strong></strong></strong></strong></h5>
<h5>
<strong>
<strong><strong>
<strong><strong>By signing the Authorisation Form, I agree to and understand                                         the following -</strong></strong></strong></strong></strong></h5>
<ul>
<li>
<strong><strong>
<strong><strong>If my child/ren is enrolled in the older program. My child has                                         my permission to attend the excursion that is listed above and that I have                                         checked. </strong></strong></strong></strong></li>
<li>
<strong><strong>
<strong><strong>I am listed on the child's Enrolment Form as a Parent or                                         Authorised Nominee.</strong></strong></strong></strong></li>
<li>
<strong><strong>
<strong><strong>I have read all of the details provided by the service and                                         understand that I can access the Excursion Risk Assessment at the service and on                                         the OWNA App.</strong></strong></strong></strong></li>
<li>
<strong><strong>
<strong><strong>I have spoken with my child about his/her safety                                         responsibilities and will ensure they are dressed appropriately and have packed                                         all required items to attend the excursion.   In the event of an                                         injury or emergency, I acknowledge that the excursion co-ordinator will attempt                                         to contact me. In an emergency, I authorise the Service to obtain all necessary                                         medical assistance, including ambulance transport, medication and hospital                                         admission. </strong></strong></strong></strong></li>
<li>
<strong><strong>
<strong><strong>The contact details, including all emergency contact details,                                         listed on my child's Enrolment Form are                                         up-to-date.</strong></strong></strong></strong></li>
</ul>
<div class="form-group">
<h5>
<strong>
<strong><strong>
<strong><label for="signature">
<strong id="signature1">E- signature and                                                 date:</strong></label></strong></strong></strong></strong></h5>
<div id="signature">
<h5>
<strong>
<strong><strong>
<strong><input name="signature-format" type="hidden"><input name="signature" type="hidden"><span class="help-text">Sign on the                                                 line with your mouse or finger</span><button class="btn btn-default" id="reset-signature" type="button">Reset                                                 Signature</button></strong></strong></strong></strong></h5>
</div>
<div id="child2-sig" style="display: none;">
<div class="form-group">
<h5>
<strong>
<strong><strong>
<strong><label for="signature">
<strong>E- signature and date for                                                         Child 2:</strong></label></strong></strong></strong></strong></h5>
<div id="signature-child2">
<h5>
<strong>
<strong><strong>
<strong><input name="signature-child2-format" type="hidden"><input name="signature-child2" type="hidden"><span class="help-text">Sign on the line with                                                         your mouse or finger</span><button class="btn btn-default" id="reset-signature-child2" type="button">Reset                                                         Signature</button></strong></strong></strong></strong></h5>
</div>
</div>
</div>
</div>
</div>
</div>
<input type="hidden" name="day01" class="toremove"><input type="hidden" name="day02" class="toremove"><input type="hidden" name="day03" class="toremove"><input type="hidden" name="day04" class="toremove"><input type="hidden" name="day05" class="toremove"><input type="hidden" name="day06" class="toremove"><input type="hidden" name="day07" class="toremove"><input type="hidden" name="day08" class="toremove"><input type="hidden" name="day09" class="toremove"><input type="hidden" name="day10" class="toremove"><input type="hidden" name="day11" class="toremove"><input type="hidden" name="day12" class="toremove"><input type="hidden" name="day13" class="toremove"><input type="hidden" name="day14" class="toremove"><input type="hidden" name="day15" class="toremove"><input type="hidden" name="day16" class="toremove"><input type="hidden" name="day17" class="toremove"><input type="hidden" name="day18" class="toremove"><input type="hidden" name="day19" class="toremove"><input type="hidden" name="day20" class="toremove"><input type="hidden" name="day01-child2" class="toremove"><input type="hidden" name="day02-child2" class="toremove"><input type="hidden" name="day03-child2" class="toremove"><input type="hidden" name="day04-child2" class="toremove"><input type="hidden" name="day05-child2" class="toremove"><input type="hidden" name="day06-child2" class="toremove"><input type="hidden" name="day07-child2" class="toremove"><input type="hidden" name="day08-child2" class="toremove"><input type="hidden" name="day09-child2" class="toremove"><input type="hidden" name="day10-child2" class="toremove"><input type="hidden" name="day11-child2" class="toremove"><input type="hidden" name="day12-child2" class="toremove"><input type="hidden" name="day13-child2" class="toremove"><input type="hidden" name="day14-child2" class="toremove"><input type="hidden" name="day15-child2" class="toremove"><input type="hidden" name="day16-child2" class="toremove"><input type="hidden" name="day17-child2" class="toremove"><input type="hidden" name="day18-child2" class="toremove"><input type="hidden" name="day19-child2" class="toremove"><input type="hidden" name="day20-child2" class="toremove"><script>
            //

            older_division = [" Monday 29th June – Meta World (Exhibitions & VR entertainment 1pm - 3:00pm) BOOKED OUT ",
                " Tuesday 30th June – Activate by Hardrock (Rock Climbing)  1:00pm - 3:00pm) BOOKED OUT ",
                " Wednesday 1st July – Caribbean Rollerama (Roller Skating or Roller Blading 1:00pm - 3:00pm) ",
" Thursday 2nd July – The Glowzone (Glow in the dark sports and games 1pm - 3:00pm) BOOKED OUT ",
                " Monday 6th July – Dreamscape (Interactive VR ride, Challenge Rooms 1pm - 3pm) BOOKED OUT ",
" Tuesday 7th July – Airoworld (Trampolining 11am - 2pm) BOOKED OUT ",
                " Wednesday 8th July – Bowling & Laser Tag (tenpin bowling, laser tag 1:00pm - 3:30pm) ", 
                " Thursday 9th July – Rainbow Town (Indoor slides, rock climbing, trampolining, dodgem cars 1:00pm - 3:00pm) BOOKED OUT "]


            Extreme_division = [" Monday 1st July – Clip and Climb ",
                " Tuesday 2nd July - Supa Park ",
                " Wednesday 3rd July – Rainbow Town ",
                " Thursday 4th July – Inflatable World ",
                " Monday 8th July – Bowling, Laser Tag & Mini Golf ",
                " Tuesday 9th July – Airoworld ",
                " Wednesday 10th July – Saboteurs Among Us ",
                " Thursday 11th July – Ninja Nation & Golf Driving Range "];
            if (Extreme_division.length == 0) {
                $('input[name="Extreme-division"]').parents('div.checkbox').hide();
                $('input[name="Extreme-division-child2"]').parents('div.checkbox').hide();
            }
            $(".toremove").remove();
            function updateOrCreateDates(dates, suffix) {
                let sectionTag = '#' + (suffix === '' ? 'child-1-section' : 'child-2-section');
                let section = $(sectionTag);

                let existing_selections = section.find('input').toArray().map(e => e.isChecked);
                section.empty();
                for (let x = 0; x < dates.length; x++) {
                    /** @type {string} */
                    let date_and_trip = dates[x];
                    let splitter = date_and_trip.indexOf('–') > -1 ? '–' : '-';
                    let date = date_and_trip.split(splitter)[0].trim().toLowerCase().split(' ').join('_');
                    let trip = date_and_trip.split(splitter).pop().trim();
                    let date_with_suffix = date + "-" + suffix;
                    let grouping_with_suffix = "days-attending" + (suffix === '' ? '' : '-' + suffix);
                    let id = date_with_suffix + '-checkbox';

                    let el = document.createElement('div');
                    el.id = id;
                    el.classList.add("checkbox");
                    let strongEl = document.createElement('strong');
                    let labelEl = document.createElement('label');
                    let inputEl = document.createElement('input');
                    if (existing_selections.length > x) {
                        inputEl.isChecked = existing_selections[x];
                    }
                    if (date_and_trip.toLowerCase().includes("no kinder division") || date_and_trip.toLowerCase().includes("booked out")) {
                        inputEl.disabled = true;
                        inputEl.isChecked = false;
                    }
                    inputEl.setAttribute('data-parsley-multiple', grouping_with_suffix);
                    var name = "day" + ((x + 1).toString()).padStart(2, '0') + (suffix === '' ? '' : '-child2');
                    inputEl.setAttribute('name', name);
                    inputEl.setAttribute('value', date);
                    inputEl.setAttribute('type', 'checkbox');
                    labelEl.append(inputEl, date_and_trip);
                    strongEl.appendChild(labelEl);
                    el.appendChild(strongEl);
                    section.append(el);

                }
            }

            updateOrCreateDates(older_division, '');
            updateOrCreateDates(older_division, 'child2');



            $('input[name="Extreme-division"]').change(function () {
                let trips = $('input[name="Extreme-division"]')[0].checked ? Extreme_division : older_division;
                updateOrCreateDates(trips, '');
            });




            $('input[name="Extreme-division-child2"]').change(function () {
                let trips = $('input[name="Extreme-division-child2"]')[0].checked ? Extreme_division : older_division;
                updateOrCreateDates(trips, 'child2');
            });

            signature = $('#signature')
            signature.jSignature()
            $('#reset-signature').click(function () { signature.jSignature('reset') });
   /*          $('#form1').removeAttr('onsubmit');

            $('#form1').parsley({
                errorClass: 'has-error',
                classHandler: function (ParsleyField) { return ParsleyField.$element.parent() },
                errorsContainer: function (ParsleyField) { return ParsleyField.$element.parent() },
                errorsWrapper: '<ul class="parsley-errors-list help-block"></ul>',
                errorTemplate: '<li></li>'
            });
 */
            $('#select-all-days').click(function () {
                $('input[data-parsley-multiple="days-attending"]').filter((i, el) => !el.disabled).prop('checked', true)
            });

            $('#select-all-days-child2').click(function () {
                $('input[data-parsley-multiple="days-attending-child2"]').filter((i, el) => !el.disabled).prop('checked', true)
            });

            $('#add-child').click(function () {
                $('#child2').show()
                $('#button-remove-child').show()
                $(".child2-required").attr("required", "true");
                $('#button-add-child').hide()
                $('#child2-sig').show()
                $('#signature1').text('E- signature and date for Child 1:')
                try {
                    signaturechild2.jSignature('getData', 'base30')
                }
                catch (e) {
                    signaturechild2 = $('#signature-child2')
                    signaturechild2.jSignature()
                    $('#reset-signature-child2').click(function () { signaturechild2.jSignature('reset') });
                }
            });

            $('#remove-child').click(function () {
                $('#button-remove-child').hide()
                $('#button-add-child').show()
                $('#child2').hide()
                $(".child2-required").removeAttr("required");
                $('#child2-sig').hide()
                $('#signature1').text('E- signature and date:')
                $('#child2 input').val("")
                $('#child2 input').prop('checked', false)
            });








/*             $("#form1").submit(function (event) {
                var hasCaptcha = $('#form1 input[name="cdo-recaptcha-response"]').val() !== "";
                if ($('#child2').css('display') != 'none') {
                    if (false === $('#form1').parsley().validate()) {
                        return false;
                    }
                }
                else {
                    if (false === $('#form1').parsley().validate('block1')) {
                        return false;
                    }
                } 
                if ($('#child2').css('display') != 'none') {
                    if (signature.jSignature('getData', 'base30')[1] != "") {
                        sigdata = signature.jSignature('getData', 'svgbase64');
                        $('input[name="signature-format"]').val(sigdata[0]);
                        $('input[name="signature"]').val(sigdata[1]);
                    } else {
                        alert("Please Sign for Child 1");
                        event.preventDefault();
                    }
                    if (signaturechild2.jSignature('getData', 'base30')[1] != "") {
                        sigdata = signaturechild2.jSignature('getData', 'svgbase64');
                        $('input[name="signature-child2-format"]').val(sigdata[0]);
                        $('input[name="signature-child2"]').val(sigdata[1]);
                        if (!hasCaptcha) {

                            alert("Captcha is required");
                            event.preventDefault();
                        }
                    } else {
                        alert("Please Sign for Child 2");
                        event.preventDefault();
                    }
                } else {
                    if (signature.jSignature('getData', 'base30')[1] != "") {
                        sigdata = signature.jSignature('getData', 'svgbase64');
                        $('input[name="signature-format"]').val(sigdata[0]);
                        $('input[name="signature"]').val(sigdata[1]);

                        if (!hasCaptcha) {

                            alert("Captcha is required");
                            event.preventDefault();
                        }
                    } else {
                        alert("Please Sign");
                        event.preventDefault();
                    }
                }
            });
*/
            //
	</script>
<p>
<strong> </strong></p>
    </div>
</div>
</co:body>
			</div>
			

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	<input type="hidden" class="js-recaptcha-input" name="cdo-captcha-response" value="" data-div-id="51a7262f-fbd7-4e77-bce9-dfebf0601885" data-processed="false" />
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