Chidon Trip 5785

Child's Full Name*

First Name Last Name

Birth Date*

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Child's Address*

Street Address
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Child's Phone Number

Child's School*

Child's grade (2025)*

Please select which camp your child is attending.

*

Girls - Primary Chidon Trip $200 - 8th - 9th JuneGirls - High School Chidon Trip - $100 - 8th - 9th JuneBoys - Primary Chidon Trip - $200 - 8th-9th JuneBoys - High School Chidon Trip - $100 - 8th - 9th June

Parent 1 Full Name*

First Name Last Name

Parent 1 Phone Number*

Parent 1 E-mail*

Parent 2 Full Name

First Name Last Name

Parent 2 Phone Number

Parent 2 E-mail

Emergency Contact (other than parents)

Emergency Contact Full Name*

First Name Last Name

Emergency Contact Phone Number*

Emergency Contact Relationship*

Medical Information

IMPORTANT: WE REQUIRE A COPY OF YOUR CHILD'S IMMUNISATION RECORD PRIOR TO ACCEPTANCE INTO THE CAMP PROGRAM.

Current GP Name*

Medicare: Child's name on card*

Medicare - Card Number*

Medicare - Child's number on card*

Medicare Expiry Date (MM/YYYY)*

Private Health Insurance Fund*

Private Health Insurance Fund Card Number*

Current Medication (if not applicable, write n/a)*

Allergies (If not applicable, write n/a)*

Medical Conditions (if not applicable, write n/a)*

Special Remarks

VACATION CARE AUTHORISATION FORM

Collecting your child from the Chabad Youth OSHC premises

We recommend all children are to be picked up by a Parent or an Authorised Nominee directly from the Chabad Youth OSHC premises. An Authorised Nominee means a person who has been given permission by a parent or family member to collect the child from the education and care service.

If you would like for your child to walk home by themselves, or to a location to be picked up, in accordance with Regulation 99(4)(b), they will need to be signed out by a Chabad Youth OSHC staff member and/or volunteer before exiting the premises.

Please tick all that apply*

I'll be picking my child up directly from the VAC premises.I give permission for my child to leave the premises by themselves and to be signed out by a Chabad Youth OSHC staff member and/or volunteerI nominate the following people as my Authorised Nominee(s), please include any siblings that may collect your child. (Please list nominees below)

Authorised Nominees:

Authorised Nominee 1 Full Name

First Name Last Name

Authorised Nominee 1 Phone Number

Authorised Nominee 1 Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Authorised Nominee 2 Full Name

First Name Last Name

Authorised Nominee 2 Phone Number

Authorised Nominee 2 Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Authorised Nominee 3 Full Name

First Name Last Name

Authorised Nominee 3 Phone Number

Authorised Nominee 3 Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

*

I hereby authorise a Chabad Youth OSHC staff and/or volunteer to obtain any medical care necessary for my child, including from a medical practitioner, hospital or ambulance service. I understand that transportation to receive medical care may include an ambulance and I agree to pay for any costs involved with seeking medical care for my child. I understand that in the case of an emergency of significant illness or injury attempts will be made to contact myself or an authorised nominee, as soon as practical

I hereby authorise Chabad Youth OSHC staff and/or volunteers to photograph my child and use the photographs for any YBR OSHC for the following purposes:*

Yes, Educational PruposesYes, Promotional PurposesYes, Social Media

*

I hereby acknowledge that I will/have read, understood and agree to the terms outlined in the Family Handbook (copies available on this website)

*

I will provide Chabad Youth OSHC and/or volunteers with documentation regarding any medical conditions for my child and attached the relevant and up to date Medical Management Plans

*

I understand that if my child has a Medical Management Plan I will be required to complete a Risk Minimisation Form and a Communication Plan in consultation with Chabad Youth staff and/or volunteers.

I allow my child to take part in water based activities*

YesNo

I give permission for my child to have a band aid administered*

YesNo

I give permission for my child to have sunscreen applied*

YesNo

The approved provider of the program has sighted my child's health record*

YesNo

Authorisation for Excursion Form:

Our service has organised an excursion for your child to attend. All of the relevant details are provided below for your convenience. The service has conducted an Excursion Risk Assessment which is available for your review upon request. For your child to attend, you are required to read this information and complete the Authority for Excursion Form. To complete this Form, you must be listed on the child’s enrolment record as either their parent or an Authorised Nominee.

Child's Full Name*

First Name Last Name

Mode of transport for all excursions: Charter Bus. All busses are fitted with seat belts.

Educator Ratio for all excursions will be 1:7.

Date of Excursions and Destinations:

Girls Primary and High School Camps.:

8 June World Series Paintball (World Series Paintball, 9 Hamilton St, Oakleigh, VIC 3166 ) travel time 30 minutes. Leave 88 Hotham St, East St Kilda 12:30pm, leave trip 3:00pm and travel to Bayside Rock Indoor Rock Climbing. Activity: Campers will have the opportunity to play paintball. Expected number of participants: 50 campers, 5 staff, 8 volunteers.

Bayside Rock Indoor Rock Climbing (Bayside Rock 9 Network Drive, Carrum Downs, VIC 3201) travel time 30 minutes. Leave World Series Paintball, 9 Hamilton St Oakleigh VIC 3166 at 3:00pm, leave trip at 5:00pm and travel to Point Leo Camp. Activity: Campers will experience Indoor rock climbing. Expected number of participants: 50 campers, 5 staff, 8 volunteers.

Point Leo Camp (114 Point Leo Rd, Shoreham VIC 3916) travel time 45 minutes. Leave Bayside Rock 9 Network Drive, Carrum Downs VIC 3201 at 5:00pm, arrive at Point Leo 5:45pm.

9 June Enchanted Adventure (Enchanted Adventure, 55 Purves Rd, Arthurs Seat VIC 3936) travel time 15 minutes. Leave Point Leo Camp 10:20am, leave trip 12:45pm and return to 88 Hotham St. Activity: Campers will explore Enchanted Adventure. Expected number of participants: 50 campers, 5 staff, 8 volunteers.

Boys Primary and High School Camps.:

8 June Fun Planet (Riverside Plaza Shopping Centre, 8025 Goulburn Valley Highway, Kialla VIC 3631) travel time 2 hours 15 minutes. Leave 88 Hotham St, East St Kilda 1:30pm, leave trip 6pm and travel to Camp Kookaburra. Activity: Campers will experience Fun Planet. Expected number of participants: 70 campers, 8 staff, 10 volunteers.

Camp Kookaburra (Camp Kookaburra, 138 Darrigan Rd, Corop VIC 3201) travel time 45 minutes. Leave Fun Planet (8025 Goulburn Vally Highway, Kialla VIC 3631) 6pm, arrive Camp Kookaburra 6:45pm.

9 June Laser Skirmish (315 South Mountain Rd, Heathcote Junction, VIC 3758) travel time 1 hour. Leave Camp Kookaburra 9:30am, leave trip 1:45pm and return to 88 Hotham St. Campers will play laser skirmish. Expected number of participants: 70 campers, 8 staff, 10 volunteers.

Reason for excursion: Excursions during vacation care are for children to develop an understanding of belonging to groups and communities and to learn to interact in relation to others with care, empathy and respect. The excursions create a fun learning environment with physical activities.

Transportation Details (to and from): The most convenient and safest route as determined by the bus driver at the time. They will be going by private charter bus with seatbelts.

Staff to child ratio: Will be a minimum of 1:7. Up to 60 children with 6 staff and 9 volunteers.

The Period the Child will be Away from the Service Premises Children will be off premises for approx. 3 - 4 hours (unless on a full day excursion).

Authority for my Child to Attend the Excursion:

Parent Full Name*

First Name Last Name

Relationship to child*

*

By submitting this form, I agree to and understand the following:

My child has my permission to attend the excursion listed.
I am listed on the child’s Enrolment Form as a Parent or Authorised Nominee.
I have read all of the details provided by the service and understand that I can access the Excursion Risk Assessment at the service.
I understand that all written policies and procedures for transporting children are available at the Chabad Youth office and on our website.
The contact details, including all emergency contact details, listed on my child’s Enrolment Form are up-to-date. If not, I have provided the updated contact details above.

*

I confirm my child's suitability to participate in the activities.

Payment Information

Cost: Primary School Camps: $200,

High School Camps: $100.

Please note that CCS does not apply to absent days at the start or end of a day camp program. Parents will be liable for the full fee.

Please note payment MUST be received BEFORE your child attends camp.

Government subsidies are available. Payment will be processed after childcare deductions have been calculated. If you choose to pay by another method leave the credit card form blank, however your child's place will not be confirmed until your payment has been received.(There is a 3% surcharge for American Express payments.)

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Chidon Trip 5785

Medical Information

IMPORTANT: WE REQUIRE A COPY OF YOUR CHILD'S IMMUNISATION RECORD PRIOR TO ACCEPTANCE INTO THE CAMP PROGRAM.

VACATION CARE AUTHORISATION FORM

Collecting your child from the Chabad Youth OSHC premises

Authorisation for Excursion Form:

Authority for my Child to Attend the Excursion:

Before you submit:

1. Have you answered all the questions in full?

2. Does your child have a hubworks profile? If you are unsure, check with the office.

3. Have you sent your child's immunisation record through, they will not be accepted into camp without it.

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