July 2012 Holiday Program - Grey Street Primary School

Parent/Guardian Information

Full Name

Email

Address

Phone

Mobile

Child/ren’s Full Name/s

1
2
3
4

Place your highest CCB% %

If you are already Registered with one of our Programs please click here: Which Program? Please Select...Bayswater North Primary SchoolBoronia West Primary SchoolDoncaster Gardens Primary SchoolEastwood Primary SchoolFairhills Primary SchoolGlenferrie Primary SchoolGrey Street Primary SchoolHealesville Primary SchoolThe Patch Primary School

Day	Date	Desc	Cost	Child 1	Child 2	Child 3	Child 4
Mon	02-Jul-2012	Winter Wonderland (Lunch Provided)	63.00
Tue	03-Jul-2012	Dine Out and Play About (Lunch Provided)-Excursion	80.00
I understand a Risk Assesment will be preformed for this day. (required)
Wed	04-Jul-2012	Creation Madness Day	55.00
Thu	05-Jul-2012	Let’s Go Wild!	55.00
Fri	06-Jul-2012	Create It- Airbrush Tattooing (Incursion)	70.00
I understand a Risk Assesment will be preformed for this day. (required)
Mon	09-Jul-2012	Creepy, Crawly Sensation Day	55.00
Tue	10-Jul-2012	Be A Rockstar For A Day (Incursion)	70.00
Wed	11-Jul-2012	Viva La France!	55.00
Thu	12-Jul-2012	Meet Australian Sharks & Rays -Excursion	90.00
I understand a Risk Assesment will be preformed for this day. (required)
Fri	13-Jul-2012	Wacky Science Day	63.00
TOTAL (before CCB% Adjustment):
Total Estimated CCB Reduction:
Estimated 50% CCR:

NOTE:	Not all families may be eligible for CCB and the 50% CCR.
	The above cost calculations are calculated on 50 approved hours. To find out if you are eligible for both CCB entitlements and eligible hours contact the Family Assistance Office on 13 61 50.

Additional Information Required:

Which Primary School does your Child/ren attend?
Have you completed a 2012 Enrolment Form (per child)?	Please select...YesNo
	Note: Note: If you have indicated 'Yes', but truly have not provided OSHCare 4 KIDS an Enrolment Form (per child) and other required/supporting documentation. You will not be provided notice and your child/ren's booking will be suspended and not processed.
Does your child/ren have a health/dietary need/s?	Please select...YesNo
Please select those conditions that effect your child/ren:	Anaphylaxis Dairy Intolerance Asthma Epilepsy Aspergers Diabetes Autism Other:
How would you like to pay?	Please select...Direct Debit from my nominated bank/credit card account (Valid only until 27-Jun-2012)Credit Card via Secure Online FormIn person at Head Office (booking will not be confirmed until payment is made)
	Card Type: Please select...VisaMastercard Credit Card Number: CVV Security Number: This is a 3 digit number usually near the signature panel. Expiration Date: MayJunJulAugSepOctNovDecJanFebMarApr2012201320142015201620172018201920202021
I agree, accept and have read to all the Programs and Company Terms & Conditions and I understand and accept all booking, cancellation, behavioural management and risk assesment policies and procedures.	Please select...YesNo
Verification Code	reload image
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Disclaimer: I understand and acknowledge once I have submitted the online Holiday Program Booking Form it is a confirmation of my child/ren’s individual booking day/s. I understand and accept that OSHCare 4 KIDS will debit my nominated account (if selected) total and/or past debt amounts once the Holiday Program Booking Form has been submitted. It is my responsibility to contact OSHCare 4 KIDS Head Office if I have not received a statement after submitting the Holiday Program Booking Form.