Excursion Authorisation Form

Excursion Form
Itinerary:
1:30pm leave Moorabbin
1:50pm Jewish Museum 26 Alma Road St Kilda (estimated 1-1 1/4 hour there).
3pm approx travel to Carlisle st.
Spend 40 minutes on a ‘scavenger hunt’
Walk and see the various different kosher & Jewish stores (including the famous Glicks), and Golds bookstore.
Finish by 4pm and head back to Moorabbin.

To be confirmed: a visit to the scribe at 4pm, which would make the return time closer to 5.

Please send $12/admission for the museum and your daughter may want to buy herself something yummy from the bakery. (Max $10)
Childs name
First Name Last Name
I authorise Leah Greenbaum to accompany my child from 5 Exley Drive Moorabbin on Wednesday July 10 and to transport my child in her own vehicle.

I hereby authorise L’Chaim Chabad- Kingston & MHC leaders and staff to obtain any medical care necessary for my child. I understand that in the case of emergency of any significant illness or injury, attempt will be made to contact myself when practical. I agree to pay for any cost that may occur as a result of the injury/illness.
I agree to the above declarations.
Mothers Full Name*
First Name Last Name
Mothers best contact number on the day

Area Code Phone Number
Fathers Full Name
First Name Last Name
Fathers best number contact on the day
Alternate emergency contact on the day
First Name Last Name
Alternate emergency contact number
DATE

Month Day Year
at Hour Minutes
Should be Empty:

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Excursion Form