KidzArtz Regsitration 2017 If you have issues with this online application, please print this paper form. You may also ring the office on 4782 1608 Child's First Name: Child's Surname: Date of Birth (dd/mm/yyyy) : School Year : K123456+ Which days do you want to register your child for? Tue Wed Thurs Fri *** ATTENTION *** Sorry, we are unable to accept children who are sick. If illness prevents your child from attending you may be eligible for a refund. Parent's Name: Email for copy of this application: Phone Number : Address : Emergency Contact (if parent/gardian cannot be reached) : Is anyone restricted from seeing your child?: YesNo If so, who? Are there any allergies, health or other concerns which it may be helpful for us to be aware of? YesNo If so, what are they? Medicare Number: Reference Number: Expiry Date : Tetanus Booster is up to date: YesNo Last Tetanus Booster (if known): We take individual photos for use during KidzArtz. Please contact us if you have any concerns about this. I give my permission for leaders to obtain medical treatment in an emergency. YesNo Date (dd/mm/yyyy): Please note: In an emergency all attempts will be made to contact you. This permission is sought if, despite our best efforts, we are unable to contact you. The leadership of each group mentioned above will treat the information contained in this form with confidentiality. This information may be shared with a third party when it concerns the medical health or care of your child. If you wish to access this information or have any queries in the relation to the manner in which we handle your personal information, please do not hesitate to call us.