Going Wild Holiday Club

**Come Join the Fun at Going Wild!**

For kids at school in kindergarten to year 6

When: Thursday 9th & Friday 10th October
9:00 AM – 3:00 PM (registrations open from 8:30 AM)

Where: Orange Baptist Church, 59–61 Sale Street, Orange

Cost: $30 per child – includes all activities, morning tea, and a free sausage sizzle dinner for the whole family at the Family Fun Evening!

What to bring: Lunch and a drink bottle

Family Fun Evening: Saturday 11th October, 4:00–6:00 PM

Spaces are limited – register below to secure your spot!

Child Information

You will need to fill out a new registration form for each of your children attending Going Wild.

Name:

First

Last

Preferred Name:

Date of Birth:

School:

School Year:

Please name a friend that is also attending: (if applicable)

Parent / Guardian Information

Name:

First

Last

Phone:

Email:

Address:

Address Line 1

City

State / Province / Region

Postal Code

Emergency Contact (in case parent/guardian is unavailable)

Name:

First

Last

Relationship to Child:

Phone:

Supporting Your Child

We want every child to feel safe, happy, and included during our holiday program. Please let us know if there’s anything that will help us support your child.

Does your child have any medical, developmental, or learning needs we should be aware of? (e.g. autism, ADHD, anxiety, sensory processing differences, hearing/vision needs, medical conditions)

Medical Conditions
Developmental / learning needs
Behavioural / sensory needs
None

please list:

Medical Conditions

please list:

Developmental / learning needs

please list:

Behavioural / sensory needs

Is your child on any medication?

Yes
No

please specify:

Does your child have any Allergies or food intolerance?

Yes
No

please specify:

My child may find these situations challenging:

please list:

Things that help my child feel safe, calm, and included:

What works best if my child becomes upset, anxious, or dysregulated:

Activities or environments my child especially enjoys:

Does your child need extra supervision or support during the program?

Yes
No

please describe:

Anything else we should know to make this a positive experience for your child:

Would you like the leader who supports children with additional needs to contact you before the program?

Yes, please contact me
No, that’s not needed

Contact Details:

Please include your name, best contact number, and preferred Day/Time to call

Permissions and Declaration

Permissions and Consents

I give permission for my child to participate in all activities.
In case of emergency, I hereby authorise the staff/volunteers to seek medical assistance, and I agree to be responsible for all associated expenses.
I give permission for my child to be photographed/filmed for church promotional purposes.
I would like to receive information about future holiday kids programs

Declaration and Signature

I, the undersigned, confirm that the information provided in this registration form is accurate and complete to the best of my knowledge. I agree to the participation of my child in Going Wild. I acknowledge and accept that my child must follow the program rules and safety instructions. I acknowledge and accept that Going Wild staff and volunteers will take reasonable care to ensure the safety of all children. I release Orange Baptist Church and its staff and Volunteers from liability for any injury, loss, or damage that may occur, except where caused by proven negligence.

to please Date

Signature

Clear Signature

Payment

Going Wild Ticket

Price: $30.00

Square

Card

Name on Card

Come Join the Fun at Going Wild!

For kids at school in kindergarten to year 6

When: Thursday 9th & Friday 10th October 9:00 AM – 3:00 PM (registrations open from 8:30 AM)

Where: Orange Baptist Church, 59–61 Sale Street, Orange

Cost: $30 per child – includes all activities, morning tea, and a free sausage sizzle dinner for the whole family at the Family Fun Evening!

What to bring: Lunch and a drink bottle

Family Fun Evening: Saturday 11th October, 4:00–6:00 PM

Spaces are limited – register below to secure your spot!

Child Information

Parent / Guardian Information

Emergency Contact (in case parent/guardian is unavailable)

Supporting Your Child

Permissions and Declaration

Payment

**Come Join the Fun at Going Wild!**

When: Thursday 9th & Friday 10th October
9:00 AM – 3:00 PM (registrations open from 8:30 AM)