Child First Name* Child Middle Name Child Last Name* Current Grade* 3 4 5 6 Parent First Name* Parent Middle Name Parent Last Name* Parent Contact Number* Parent Email* My child has attended the Chabad Malvern Holiday Program in 2024-25 and has filled out the OWNA Child Information Form* If not, please click here to fill it out before continuing . All Days Child 2: Child 2 First Name* Child 2 Middle Name Child 2 Last Name* I have completed a Chabad Malvern OWNA Child Information form for Child 2* If not, please click here to fill it out before continuing . All Days Remove Child Add Child PAYMENT INFORMATION: Bookings close 27th June or if places filled prior. Price $300 minus eligible CCS rebate. Cancellations after 27th June will still be charged full fees. Name on Credit Card* Credit Card Number* Expiry* January February March April May June July August September October November December 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 CVV* EXCURSION PERMISSION FORM 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. 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 will be for approx. 3 - 4 hours. Leaving and returning times as above. Please note the approximate number of expected children is 59. Our Diploma Qualified Educators are Menucha Cooper, Reuvi Cooper, Yossi Smoller, Ita Smoller, who will be together with Nicolle Aldana, and volunteers. Authority for my Child in Program to Attend the Excursion: By signing the Authorisation Form, I agree to and understand the following - 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. I am listed on the child's Enrolment Form as a Parent or Authorised Nominee. 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. 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. The contact details, including all emergency contact details, listed on my child's Enrolment Form are up-to-date. E- signature and date: Sign on the line with your mouse or fingerReset Signature E- signature and date for Child 2: Sign on the line with your mouse or fingerReset Signature This page uses 128 bit SSL encryption to keep your data secure.
