School Holiday Learning Journey Consent
Please complete this form to register your child for the school holiday learning journey and share the details needed for safe participation.
Student Information
Student full name
*
First Name
Middle Name
Last Name
Date of birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current school year or grade
*
Please Select
Prep
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Other
Additional student details
Parent or Guardian Information
Parent or Guardian Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Legal Guardian
Step-Parent
Grandparent
Foster Parent
Other
Email Address
*
example@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Contact Method
*
Email
Mobile Phone
Either
Learning Journey Details
Preferred holiday program session
*
Please Select
Session 1
Session 2
Session 3
Other
Attendance preference
*
Full day
Half day
Learning interests or subjects
Reading
Maths
Science
Arts and crafts
Sports
Outdoor activities
Technology
Music
Other
Schedule notes or availability constraints
Safety, Health, and Support Information
Allergy Information
Medical Conditions
Accessibility Needs
Behavioral or Learning Support Notes
Emergency Contact Name
*
First Name
Middle Name
Last Name
Pickup and Authorization Details
Approved Pickup Persons
*
Permission for Supervised Activities and Outings
*
Yes
No
Pickup Restrictions or Special Instructions
Additional Authorized Pickup Details
Consent and Submission
Parent or Guardian Signature
*
Submit Consent
Submit Consent
Should be Empty: