Student Details

First Name

Last Name

Parent/Guardian's names

Contact Details

Address

Suburb

Postcode

Phone Number

Mobile Number

Email address

Emergency Contact Name

Emergency Contact Number

Fees

 Camp Fees - $160 Optional Linen (inc towels) - $15

Special Needs

Medication needs:

 Yes No

Anaphylaxis:

 Yes No

Additional Educational Needs:

 Yes No

Dietary Requirements:

 Yes No

Asthma:

 Yes No

Allergies:

 Yes No

Diabetes:

 Yes No

Epilepsy:

 Yes No

Injuries:

 Yes No

If you have selected "Yes" to any of the above, please provide more information:

Allergies

 N/A Pollens Dust Mites Plants (inc. trees, grass etc) Nuts Gluten Dairy Egg Chlorine Insect Stings Other

Please explain reaction(s)

Other Details

Can your child swim?:

 Yes No

Is your child interested in horse riding?:

 Yes No

Is your child afraid of heights?:

 Yes No

In the case of an emergency, do you give permission for our teachers to call 000, and perform first aid on this student if the situation requires it, and agree to incur the costs of that service?:

 Yes No