Holiday Program

Restoration Station

Seaforth Anglican Church

Monday 20 July 8.30am drop off and 3.00pm pick up

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Holiday Program Restoration Station (Seaforth Anglican Church)
20 Jul, 2026 8:30 AM
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Your Email Address

Child's First Name

Child's Last Name

Date of Birth

School Name

School Grade

Allergies / Medication /Activity Restrictions /Behavioural Issues etc

I prefer to pack food for my child

Doctor Name

Doctor Contact Number

Medicare Number

Date of Last Tetanus

I permit photos/videos of my child to be taken at the Holiday Program which may be displayed publicly (online and in print)

Is there anyone who is legally restricted from seeing your child?

Please attach copies of any supporting documentation (eg: AVO or Family Court Order)

I understand by registering my child I permit my child to participate fully in the Holiday Program.

I give my permission, in the case of a medical emergency, to the doctor chosen (either by the church authorities or other persons supervising or administering the activities), to use an ambulance if needed and to secure proper treatment for and/or hospitalisation, injection, anaesthetic or surgery for my child. I understand that every effort will be made to contact me prior to such procedures.

Emergency Contact 1

Emergency Contact 1 Telephone

Emergency Contact 2

Emergency Contact 2 Telephone