CKids Club-General enrolment - JewishMelbourne.com.au

Are you a JAE Family?*

yesno

Upcoming Event - Rosh Hashana Airlines

CHILD 1 INFORMATION

Child 1 Full Name*

First Name Last Name

NIckname name they like to be called

Birth Date

Day Month Year

School

Grade 2024*

MEDICAL INFO & EXTRA NEEDS

GP Name

GP Number

Any Allergies?*

please write NA if none

Medical Conditions (asthma or others)? *

please write N/A if none

Special Comments

CHILD 2 INFORMATION

Child 2 Full Name

First Name Last Name

Child 2 Nickname name they like to be called

Birth Date

Month Day Year

School

Grade 2024

Child 2 MEDICAL INFO & SPECIAL NEEDS

GP Name

GP Number

Any Allergies?

please write NA if none

Medical Conditions (asthma or others)?

please write N/A if none

Special Comments

FAMILY INFORMATION

Address

Street Address
Street Address Line 2
City	State
Post Code	Country

Family E-mail

Parent 1 *

First Name Last Name

Contact Number*

Phone Number

Parent 2

First Name Last Name

Contact Number

Phone Number

Home Phone Number

Area Code Phone Number

Emergency Contact other than Parents*

First Name Last Name

Emergency Contact Number *

Area Code Phone Number

Authorised Person1 to collect the child

First Name Last Name

Authorised Person 1 phone contact

Authorised Person2 to collect the child

First Name Last Name

Authorised Person 2 phone contact

AUTHORISATIONS

Medical Authorisation*

I hereby authorise a L'Chaim Chabad or Moorabbin HC 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 L'Chaim Chabad or Moorabbin HC staff and/or volunteers to photograph my child and use the photographs for L'Chaim Chabad or Moorabbin HC for the following purposes:

yes, Educational purposesyes, promotional materialyes, social media

COST:
JAE Family: $18/Child $30/2 Siblings
Non JAE Family: $20/Child $36/2 Siblings

JAE Family Payment $18 for 1 child $30 for 2 siblings*

$18$30

Payment amount $20 for 1 child $36 for 2 siblings*

$20$36

Payment

Credit Card Direct Debit

Child Info for Special Events