APPLICANT INFORMATION

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Edith Lee
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APPLICANT INFORMATION APPLICANT INFORMATION Surname: CHILD #1 CHILD #2 CHILD #3 CHILD #4 First Name: Date of Birth: Age: Name

you like to receive Emails from Karratha Leisureplex with information and application forms for the future School Holiday

M: MEDICAL DETAILS Please indicate any medical and/or behavioural conditions that your child/children currently have or have

further information is required** Child s Name Condition Medication?

1 APPLICANT INFORMATION APPLICANT INFORMATION Surname: CHILD #1 CHILD #2 CHILD #3 CHILD #4 First Name: Date of Birth: Age: Name of Parent/Guardian (Emergency contact): Address: Address: Telephone: H: W: M: Alternate Emergency Contact: Yes No Would you like to receive s from Karratha Leisureplex with information and application forms for the future School Holiday Activities and Term Program? M: MEDICAL DETAILS Please indicate any medical and/or behavioural conditions that your child/children currently have or have had. **Please ensure a Medical Alert form is completed IN FULL and attached to the child s enrolment form if medication or further information is required** Child s Name Condition Medication? Yes / No Yes / No PERMISSION TO BE PHOTOGRAPHED Do you give permission for photos to be taken for display and publicity purposes, including advertisements, brochures, websites and social media? CHILD #1 CHILD #2 CHILD #3 CHILD #4 PARENT SIGNATURE: Yes / No Yes / No Yes / No Yes / No

2 HOLIDAY ACTIVITIES Please tick ( ) which days your child/children will attend CHILD #1 CHILD #2 CHILD #3 CHILD #4 Monday 18 th December Basketball 9.00am-1pm, 6-12 year olds Tuesday 19 th December Amazing Food & Christmas Craft Week 1 Wednesday 20 th December Futsal Games Wednesday 20 th December Wet n Wild (Day 1) Thursday 21 st December Christmas Movies Friday 22 nd December Sport and Fitness Monday 8 th January Mega Sports Day Tuesday 9 th January Art Attack Week 2 Wednesday 10 th January Futsal Games Wednesday 10 th January Wet n Wild (Day 2) Thursday 11 th January Racquet Sports Friday 12 th January Intro Gymnastics

3 HOLIDAY ACTIVITIES Please tick ( ) which days your child/children will attend CHILD #1 CHILD #2 CHILD #3 CHILD #4 Monday 15 th January Basketball v Netball 9.00am-1pm, 6-12 year olds Tuesday 16 th January Indoor Hockey Week 3 Wednesday 17 th January Indoor Oz Tag Wednesday 17 th January Cup Cake Wars & Games Thursday 18 th January Synchronized Swimming & Cricket Friday 19 th January Intro Gymnastics Monday 22 nd January Mega Sports Day & Yoga Monday 22 nd January Craft Creations Tuesday 23 rd January Indoor Oz Tag Week 4 Tuesday 23 rd January Science & Giant Games Wednesday 24 th January Intro Dance Hip Hop Wednesday 24 th January Wet & Wild (Day 3) Thursday 25 th January Intro Gymnastics Thursday 25 th January Flippa-Ball (Water Polo)

4 TERMS & CONDITIONS To provide a well organised and safe program, the following conditions have been devised. Your cooperation in complying with the following conditions will assist us to provide safe and enjoyable Holiday Activities for your children. I understand and agree to the procedure of fee payments, refunds and penalty payments as set out below: All parents must keep their registration form details up to date. Fees are to be paid in advance when booking a place. Choose carefully as there are NO REFUNDS. If a child is collected late without a good reason there will be a charge of $10 per quarter hour, per child. 1. MEDICATION If your child requires medication or drugs whilst at the Karratha Leisureplex, these must be given to a member of staff to be kept in the office, and the procedures for administering drugs must be followed. Under no circumstances must a child keep medication in their bags or lunchboxes or administer them themselves. A medication permission form will need to be filled out and signed by the parent/guardian. These are available from Reception. 2. CHILD S PARTICIPATION I will not bring my child if they are ill and/or unable to participate in the regular activities of the program. I have read Karratha Leisureplex Behaviour Policy and agree with Karratha Leisureplex staff members following the procedures outlined. I understand that if my child/children continually behave in an inappropriate manner I will be required to collect them and they may be excluded from future activities. DECLARATION I confirm that I have read, understood and agree to the information provided pertaining to my child/children s participation in the Karratha Leisureplex School Holiday Activities. I have disclosed all relevant information regarding physical, mental or other health conditions which could be aggravated, worsened or impacted by physical exercise or participation in activities by my child/children. I have read and agree to the Karratha Leisureplex Behaviour Policy. I agree that the City of Karratha, Karratha Leisureplex and its officers, leaders and staff shall be released from and shall not incur any responsibility or liability whatsoever for any accident or injury to the participant(s) or any damage or loss of property of the participant(s). Signature: Date: PAYMENT METHOD - If enrolling via , please fill out your credit card details below: Amount Paid: $ Visa / MasterCard Card Number: CCV # Name on Card: Expiry: / Signature: Return completed form to the Programs Department: Post: PO Box 219 Karratha WA 6714 In Person: Dampier Highway opposite Broadhurst Road leisureplex@karratha.wa.gov.au Date: / /

5 ENROLMENT DETAILS CHILD 1 - $28.00 ADDITIONAL CHILD - $25.00 Enrolments open Monday 4 th December 2017 Children must be aged in the relevant age category to be eligible for holiday activities Full payment is required at the time of enrolment No phone bookings will be accepted. Forms that are ed must have credit card details attached. Please choose carefully as there will be NO REFUNDS and restrictions apply to change of day requests. HOLIDAY ACTIVITY INFORMATION Starting time will be 9am or 1pm and finish just prior to 1pm or 5pm. Please ensure you sign your child in and out of the day s activities. Planned activities are subject to minor changes without notice. A $10 fee per 15 minutes will apply where children are picked up after 5pm without notification. Please ensure your child arrives with appropriate attire for the days planned activities. All personal items MUST be marked with their name. Please ensure your child is wearing appropriate footwear for physical activity with the exception of pool days. Socks and closed toed shoes are required at the Youth Shed. Children are expected to bring their own healthy snack for a scheduled break during their activities. NO NUTS PLEASE! Each day Bring: a Drink Bottle, Hat and Sunscreen, Runners & a Healthy snack for morning/afternoon tea. If your child is booked into an AM and PM activity on one day, please ensure they bring lunch with them. BEHAVIOUR POLICY Our goal is to provide activities suitable for school aged children of all backgrounds and abilities, whilst providing: A safe and engaging environment. A variety of fun and exciting activities Effective supervision for the duration of the activities Enforcing a behavior management system based on positive reinforcement, ample warnings for negative behavior and acknowledgement of achievement. The THREE STRIKE WARNING SYSTEM is acknowledged and enforced by the Leisureplex staff across all child oriented activities. 1. First Warning: The child is verbally made aware of their inappropriate behaviour and why it is not appropriate. 2. Second Warning: The child is verbally informed about their continuing behaviour and removed from the group. 3. Third Warning: If the child continues to demonstrate inappropriate behaviour, the holiday staff will contact their parent/carer for immediate collection of the child. Strikes: A third warning represents one strike. Additional strikes will be recorded for the duration of the school holiday activities. Three strikes on separate days will result in expulsion for remaining school holiday activities. If a strike is given to a child, this will be immediately communicated to the parent or carer. As expulsion is the last resort, program staff will meet with the parent or carer of a child who has received one or more strikes to discuss a resolution. Should an expulsion occur however, there will be NO REIMBURSEMENT and careful consideration will be taken when accepting the child in the future activities and term programs.

6 WEEK 1 ACTIVITIES Monday, 18 th December Basketball Tuesday, 19 th December Amazing Food & Christmas Crafts Wednesday, 20 th December Futsal Games Wednesday, 20 th December Wet and Wild Day 1 Thursday, 21 th December Christmas Movie Marathon Friday, 29 th December Sport & Fitness WEEK 2 ACTIVITIES Monday, 8 th January Mega Sports Day Tuesday, 9 th January Art Attack Wednesday, 10 th January Futsal Games ABOUT Improve your Basketball skills through small games and drills focusing on the different aspects of the game (defence, offense, agility, shooting baskets). We ll finish off with a round robin tournament. Bring your shoes, healthy snacks and a water bottle. You ll be put in a baking team and given some ingredients to create the most delicious, imaginative Christmas treats! While the creations are cooking kids will rotate through some giant games and make a craft for the Christmas Tree. Be prepared for everything! Improve your Soccer skills through small games and drills focusing on the different aspects of the game (defence, offense, agility, goal scoring). We ll finish off with a round robin tournament. Come along and join the fun in the pool! Aqua runs, surf board races, water pistols, sausage sizzle. How could a day get any better? Welcome to our big screen. Bring a cushion or a chair, maybe just a mat, whatever you need to be comfy. Its movie time and the popcorn will be popping! Then when the movies finish we ll pop another one on. Lots of sports, fitness activities & games. It s your chance to try a new sport like Basketball, Soccer, Spin, Bootcamp and more. If you like to be active this is for you it s 4 hours jam-packed with sport and fitness. ABOUT Lots of sports and games. It s your chance to try a new sport like Basketball, Soccer, Athletics, Volleyball and more. If you like sport this is for you it s 4 hours jam-packed with sport. Bring your creative minds for our Art Attack program. We ll be indoors the whole time with everyone involved. Then afterwards there s some creativity required to make a craft. Be prepared for everything! Improve your Soccer skills through small games and drills focusing on the different aspects of the game (defence, offense, agility, goal scoring). We ll finish off with a round robin tournament.

7 Wednesday, 10 th January Wet and Wild Day 2 Thursday, 11 th January Racquet Sports Friday, 12 th January Intro Gymnastics 9:00am-1:00pm WEEK 3 ACTIVITIES Monday, 15 th January Basketball v Netball Tuesday, 16 th January Indoor Hockey Wednesday, 17 th January Indoor Oz Tag Wednesday, 17 th January Cup Cake Wars & Giant Games Thursday, 18 th January Synchronized Swimming & Indoor Cricket Friday, 19 th January Intro Gymnastics 9:00am-1:00pm WEEK 4 ACTIVITIES Monday, 22 nd January Mega Sports Day & Yoga Come along and join the fun in the pool! Aqua runs, beach volleyball, water pistols, sausage sizzle. How could a day get any better? Lots of sports and games. It s your chance to try a new sport like Badminton, Squash, Tennis and more. If you like sport this is for you it s 4 hours jam-packed with different sport. Have you ever wanted to try gymnastics? Then come along to this and the qualified coaches will have all the gear an all the know-how. Next step the Olympics! Please note: no denim or skirts please. ABOUT Improve your Basketball and Netball skills through small games and drills focusing on the different aspects of each game (defence, offense, agility, shooting). We ll finish off with some games. Bring your shoes, healthy snacks and a water bottle. Improve your Hockey skills through small games and drills focusing on the different aspects of the game (defence, offense, agility, goal scoring). We ll finish off with a round robin tournament. This is an exciting new program. We will be setting up a playing field across all the Indoor Courts. To start with, you will learn the basic skills of the game working on defence and attacking skills. Afterwards you ll be placed into a team and then it is Game On!!! You ll be put in a baking team, given some secret toppings and then it s up to you to make the most delicious, imaginative cupcakes you can! While the creations are cooking kids will rotate through some giant games and casual sport activities, as well as optional craft activities. Be prepared for everything! Don t forget your swimmers and a towel and come and try the newest edition to the Holiday Program. Shaye has started teaching Synchronised Swimming recently at the Leisureplex and it has been very successful. We will rotate groups through different activities also, including some First Aid and Indoor Cricket to keep your little one very busy. Have you ever wanted to try gymnastics? Then come along to this and the qualified coaches will have all the gear an all the know-how. Next step the Olympics! Please note: no denim or skirts please. ABOUT Lots of sports and games. It s your chance to try a new sport like Basketball, Soccer, Yoga, Volleyball and more. If you like sport this is for you it s 4 hours jam-packed with sport & Yoga

8 Monday, 22 nd January Craft Creations Tuesday, 23 rd January Indoor Oz Tag Tuesday, 23 rd January Science & Giant Games Wednesday, 24 th January Intro Dance & Hip Hop Wednesday, 24 th January Wet & Wild Day 3 Thursday, 25 th January Intro Gymnastics 9:00am-1:00pm Thursday, 25 th January Flippa-Ball Games It s time to get crafty with our creative team. Very busy session to challenge the mind and open up your creative side. This is an exciting new program. We will be setting up a playing field across all the Indoor Courts. To start with, you will learn the basic skills of the game working on defence and attacking skills. Afterwards you ll be placed into a team and then it is Game On!!! Be prepared to experiment with science. You might be the next Albert Einstein. After the science session we will rotate the kids through giant games and some casual sport activities. Very busy session to challenge the mind and body. You ll be learning a routine and we re pretty confident Bruno Mars will be using it for his next film clip! Wear something funky and comfy! Come along and join the fun in the pool! Aqua runs, surf board races, water pistols, sausage sizzle. How could a day get any better? Have you ever wanted to try gymnastics? Then come along to this and the qualified coaches will have all the gear an all the know-how. Next step the Olympics! Please note: no denim or skirts please. Improve your Water Polo Skills through small games and drills focusing on the different aspects of the game (defence, offense and goal scoring etc). We ll finish off with a round robin tournament. It is preferred that you are a competent swimmer to get the most out of this program.

ADULT SOCIAL SPORT COMPETITIONS TEAM NOMINATION FORM

ADULT SOCIAL SPORT COMPETITIONS TEAM NOMINATION FORM TEAM NAME/ TWO NOMINATED CONTACTS Team name: Contact name 1: Contact name 2: Suburb: Postcode: Telephone (H): Mobile: Email: Suburb: Postcode: Telephone (H): Mobile: Email: How did you hear about this