Kool Kids Camp Enrollment Form
ABN: 55 637 079 620
Personal Details
Private Health Insurance (if applicable)
Additional Information
Are there any family, behavioural or medical conditions which we should be aware of? If the condition is not mentioned below, please state in the additional notes section below.
Dietary Requirements
Camper Details
How did you hear about camp?
In case of an emergency or a serious injury, do you give us permission to call emergency services (e.g. ambulance/police/fire department) as the first point of contact?
Emergency Contact 1
Emergency Contact 2
Child Protection and Safety Information
Empowered Therapy and Training in conjunction with Kool Kids Tutoring is committed to the safety and wellbeing of all children and young people involved in our events. To ensure that children and young people are kept safe from harm, our staff and volunteers are required to possess a current working with children check (e.g. Blue Card); agree to adhere to a code of conduct when working with children and undergo training in child safety. We take child protection and safety matters seriously and consequently has policies and procedures in place to ensure that your child has the best possible experience with us.
Permissions
All details contained within this referral form are considered to be private and confidential.
Responsibilities of the Provider
The provider agrees to:
1. Support the participant to achieve their goals, meet their needs and requirements and sensitively respond to and support their rights to practice their cultural diversity values and beliefs.
2. Communicate openly & honestly in a manner and mode in which the participant is most likely to understand, in a timely manner and where needed, we will use Auslan and or language interpreters
Select dates
Payments
You may pay online (see below) or complete a bank transfer using the following details. If you complete a bank transfer, please forward your receipt to: contact@koolkidstutoring.com.au
Name: Kool Kids Tutoring PTY LTD
BSB: 484-799
Acc Number: 050103780
Please note that a $100 deposit is required to secure your booking at this time. The remaining about of $897.00 has to be paid at least 3 weeks prior to departure.
If this is a last-minute booking (less than 3 weeks before departure), the full amount of $997.00 (GST not included) must be paid at the time of this booking.
Please add your name and 'KKT Camp' in the reference: e.g. Katie KKT Camp.
If you are an NDIS or CHILD SAFETY participant, please provide your billing address accurately (support coordinator, plan manager, self-administrator, etc.).
for example. :
name, email, phone number, organisation
Email wecare@support.empoweredtherapyandtraining.com if you have questions.
Thank you!
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Kool Kids Camp Full Payment via CHILD SAFETY
Please note that if you select this option, the payment can be processed via Child Safety Price is $997 (not including GST)Account details: Kool Kids Camps BSB 484-799Account Number: 050103780As confirmation of payment please state the child's full name.
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