Registration

Numbers for the Kids Holiday Club are limited and registration will close maximum numbers are reached. Registration involves two steps and is confirmed when payment is received. For more than one child, please register & make payment for each child separately.

1) Fill in your details in the form below & submit (this does not yet register your child)

2) You will be taken to the payment page (registration is confirmed after payment is made)

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off, Payment program?

Child's Name *

First

Last

Child's Date of Birth *

DD/MM/YYYY

Gender *

• Male
• Female

School Grade *--- Select Choice ---PrepYear 1Year 2Year 3Year 4Year 5Year 6

Name of School

Any Allergies or Relevant Medical Information?

Days Attending *

• Monday
• Tuesday
• Wednesday

Payment Amount (for this Child only) *--- Select Choice ---$30 (for 1 day)$45 (for 2 days)$55 (for 3 days)

Payment Method *

• Credit Card
• Bank Transfer (registration make take a few days)

         Registration is not confirmed until payment is made.

Parent (or Guardian) Information *

First

Last

Mobile Number *

Email *

Email

Confirm Email

Address *

Church Attending (if applicable)

How did you hear about the Holiday Kids Club?

Will another adult drop child off, sign in, pick up, or be an emergency contact during the holiday program? *

• Yes
• No

Additional Parent / Guardian / Contact

First

Last

Mobile Number

Any Further Comments

By submitting this form, you are granting consent for your child to appear in digital media, and for its reasonable use in future advertising. You can withdraw this consent in writing at any time by emailing: admin@bellbowriecc.org.au

Submit