> Olympic Park
 

Complete the form below if you would like to enrol in our next holiday clinic held at Willoughby Public School.
* The fields marked with an asterix are compulsory.

PARENT DETAILS

**Please note that each family member will have their own CRN for use when claiming CCB / CCR.

Parent Name:
*
Parent's Gender:
* (M or F)
Parent's DOB:
*
Parent's CRN:
**
Telephone:
 *
Mobile:
Email:
*
Address:
Suburb:
State:
Postcode:
Additional Child Care Information
Do you have other children at different day care services over this holiday period? If so, how many?
Percentage (if known):
Are you entitled to receive JET/JFA (only applicable if you are studying):
Yes
No
CHILD 1 Information  
Name:
*
DOB:
*
Gender:
 (M or F) *
CRN:
**
School:
Name of friend:
(if requesting to be in the same group)
CHILD 2 Information  
Name:
DOB:
Gender:
 (M or F)
CRN:
**
School:
Name of friend:
(if requesting to be in the same group)

MEDICAL DETAILS

1.
 Is your child/children on any long term medication?
Child 1
No
Yes - please supply details:
Child 2
No
Yes - please supply details:
 
2.
 Does your child / children have any known allergies or medical conditions?
Child 1
No
Yes - please supply details:
Child 2
No
Yes - please supply details:
3.
 Seek medication attention - I hereby give permission to the Moving Bodies supervisor to seek medical aid in the event of an accident, injury or illness (please tick).
4.
 Authorisation to administer medication - I give permission for a Moving Bodies staff member to administer the following medical treatment to my child / children in the case of an accident, injury or illness (please tick).
Ice pack Bandaid Elastoplast
Gauze / swab padding Sunscreen Saline solution

EMERGENCY CONTACT - Where Moving Bodies staff are unable to contact you, please indicate TWO people we can contact in the event of an emergency who can act on your behalf.

Name 1:
Relationship:
Address:
Postcode:
Mobile:
Home telephone:
Work telephone:
Name 2:
Relationship:
Address:
Postcode:
Mobile:
Home telephone:
Work telephone:

AUTHORITY TO COLLECT CHILD - Please indicate TWO people other than parents / guardians / emergency contacts who are authorized to collect your children. A note with your signature must be made on the Sign In sheet to notify that one of these contact people will be collecting your child on a given day.

Name 1:
Relationship:
Address:
Postcode:
Mobile:
Home telephone:
Work telephone:
Name 2:
Relationship:
Address:
Postcode:
Mobile:
Home telephone:
Work telephone:

ATTENDANCE DATES - Please tick below the days your child / children will be attending the Moving Bodies holiday clinic.

Date: Child 1 Child 2 Extended Hours Drop off time Pick up time
Tue 10 April 1 | 2 | 3
Wed 11 April 1 | 2 | 3
Thur 12 April 1 | 2 | 3
Fri 13 April 1 | 2 | 3
Mon 16 April 1 | 2 | 3
Tue 17 April 1 | 2 | 3
Wed 18 April 1 | 2 | 3
Thur 19 April 1 | 2 | 3
Fri 20 April 1 | 2 | 3

PLEASE READ IMPORTANT CHANGES TO METHOD OF PAYMENT

METHOD OF PAYMENT

Moving Bodies requires FULL payment to be made at the time of booking and BEFORE your child's attendance at the Holiday Clinic.

Changes to the Child Care Rebate, as of 4 July 2011, have brought child care fee reduction payments in line with the Child Care Benefit. Therefore fees may be reduced by Centrelink for parents eligible for CCB and/or CCR.

Moving Bodies will reimburse all eligible parents with their fee reduction entitlement within two weeks of the Holiday Clinic's completion. Any credits accrued will also be reimbursed at this time.

Invoices will no longer be issued. Please email info@movingbodies.com.au if you require an invoice / receipt.

Preferred payment method - Direct deposit
  Bank: NAB | BSB No: 082 309 | Acct No: 593 754 675 | Acct Name: Moving Bodies Pty Ltd
  Please use your child's name as a reference when paying.
  I have made a deposit for the amount of $ . Reference used [child's name]:
Cheque or money order
 

Cheque or money order payable to “Moving Bodies Pty Ltd”.

Please clearly print name, address and contact number on the reverse side of cheque/money order.

Return to: Moving Bodies, 27 Glenview Road, Mt Kuring-gai 2080.

 

 
Tel: (02) 9940 5240
Fax: (02) 9012 0895  

Office: 27 Glenview Rd, Mt Kuring-Gai
Email: info@movingbodies.com.au

 

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