KefKidz Enrolment Form

Parent Information
MOTHER
Given names*
Last name*
Date of Birth*
MonthDayYear
Home Address*
Street Address & Suburb
Street Address Line 2
CityState / Province
Post Code
Mobile Phone*
Area CodePhone Number
Home Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
Email*
example@example.com
Country of Birth*
Main Language*
FATHER
Given names*
Last name*
Date of Birth*
MonthDayYear
Home Address*
Street Address & Suburb
Street Address Line 2
CityState / Province
Post Code
Mobile Phone*
Area CodePhone Number
Home Phone
Area CodePhone Number
Work Phone
Area CodePhone Number
Email*
example@example.com
Country of Birth*
Main Language*
Parents' Marital Status*
Custody/ Access arrangement *
Legal Docs must be provided
Rabbi / Officiator*
Other Person Authorised to collect/ Emergency Contact Info
I/We consent for the people listed as parent/guardian/person with parental responsibilities or authorised person/s below to give permission for medical treatment, administration of medication, sign incident reports for my child and give permission to an educator to remove my child from the program or excursions or medical treatment from a registered medical practitioner, hospital or ambulance service.
Person 1
Emergency Contact Name(if parent or guardian is not avaliable)*
Relationship to child*
Emergency Number*
Area CodePhone Number
Person 2
Emergency Contact Name(if parent or guardian is not avaliable)
Relationship to child
Emergency Number
Area CodePhone Number

PERMISSION/ DECLARATION
1. Activities /Transport: I certify that my child has my permission to attend Kefkidz Holiday Program and participate in all onsite and offsite activities and be transported to all excursions (including swimming) organised as part of the program.*
Yes
2. Accidents: in the event of illness or injury to my child whilst attending the Holiday Program of Lamdeni School Inc: I authorise the coordinator or staff member(s) in charge of my child, where it is impractical to communicate with me, to seek and obtain emergency, medical, hospital or ambulance attention or service on my behalf as may be deemed necessary.*
Yes
3. Grouping: I understand that for safety and educational reasons my child will automatically be placed in his/her respective division, streamed according to school grades. In exceptional circumstances, should I have a request for change, I will notify KefKidz in writing (youth@hs.org.au) no later than 2 weeks prior to the program, and I understand that my request will only be accommodated subject to activity type and availability.*
Yes
4. Other Person authorised: I/We consent for the people listed as parent/guardian/ or other authorised person/s to give permission for medical treatment, administration of medication, sign incident reports for my child and give permission to an educator to remove my child from the program for excursions or medical treatment from a registered medical practitioner, hospital or ambulance service.*
Yes
5. Privacy: I give permission for my child's photographs/videos to be used for promotional purposes - including but not limited to Facebook, Instagram, emails, flyers and billboards.*
YesNo
6. Payments: I/We authorise to charge a minimum of $100 non-refundable deposit per week at time of enrolment and the balance not prior to 2 weeks before commencement of program. I/We further authorise Hamerkaz's admin service, Redbourne Business Services P/L t/as Child Care Central ACN 095 164588 (User ID 314011) or Hamerkaz office to debit my/our account at the Financial Institution identified above through the BECS in accordance with the payment details given in the link in the following step (service charge may also apply) and as per the Child Care Central Service Agreement and Hamerkaz Shelanu/Lamdeni School’s terms & conditions which I/we have received/read and understood.*
Yes
7. Child Care Subsidies: I hereby authorise to charge the full amount or the full amount less CCS if confirmation for CCS has been obtained latest one week prior to the program.*
Yes
8. Cancellations: I understand that no refunds/ credits for future programs will be issues for any absences or cancellations beyond 3 weeks prior to first day of program. The full amount will still be charged.*
Yes

Fees & Payment Details
Includes all excursions, activities, and food.
Total EARLY BIRD Price (this does not take into account any government subsidies which will be deducted from this total price.)
This price does not take into account your CCB/CCR.
Upon submission of this form, you will be redirected to a payment form where you will complete payment details for your child/ren. You will be invoiced the total amount payable (considering Childcare subsidies) by our accounts management, Childcare central.
This payment form must be completed in order for your child's place to be confirmed in the program.

Final Step
How did you hear about Kefkidz?*
I give permission for this enrolment form to stay valid for the remainder of 2019.*
Yes, and I will notify you if any details change.No, I'd rather complete a new enrolment form next time my child/ren attends the program.
Comments or suggestions
Email Confirmation to be sent to:*
By signing on the line below and hitting submit, I certify that all the above information is true and correct, and I agree to Kefkidz' (Lamdeni inc.) terms and conditions as per policy book (copy available at office.)
Your Name*
First NameLast Name
E-Signature*
Clear
Thank you for enrolling your child/ren into Kefkidz Holiday Program!
You will now be redirected to a mandatory payment form to complete your payment details and thereby confirm your child's enrolment into the program.
For any further enquiries, please email youth@hs.org.au.
We look forward to a fantastic program!
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KefKidz Enrolment Form | Spring 2019

Child's Personal Details

Child's Personal Details

Child's Personal Details

Parent Information

Other Person Authorised to collect/ Emergency Contact Info

PERMISSION/ DECLARATION

Fees & Payment Details

Final Step