UWA Sport Pty Ltd UWA Kids Sports Holiday Program 3 14 July 2017 - Enrolment Form – Parent/Guardian Details Given name: Family name: Phone number: Email address: Postal address: Suburb: Postcode: Registered child care receipt: yes / no (please circle) Emergency Contact Details As above: yes / no If no, please provide below. (please circle) Name: Phone number: Details Child’s Child 1: Given name: Family name: Date of birth: / /20 Gender: male / female / other (please circle) Child 2: Given name: Family name: Date of birth: / /20 Gender: male / female / other (please circle) Child 3: Given name: Family name: Date of birth: / /20 Gender: male / female / other (please circle) Medical details/conditions Payment Details Weekly Discount Costs Daily Price 8am 1pm $45 $202.50 – 8am 5pm $60 $270 –
UWA Sport Pty Ltd UWA Kids Sports Holiday Program 3 – 14 July 2017 - Enrolment Form Parent/Guardian Details Given name: Family name: Phone number: Email address: Postal address: Suburb: Postcode: Registered child care receipt: yes / no (please circle) Emergency Contact Details As above: yes / no (please circle) If no, please provide below. Name: Phone number: Child’s Details Child 1: Given name: Family name: Date of birth: / /20 Gender: male / female / other (please circle) Child 2: Given name: Family name: Date of birth: / /20 Gender: male / female / other (please circle) Child 3: Given name: Family name: Date of birth: / /20 Gender: male / female / other (please circle) Medical details/conditions Payment Details Costs Daily Weekly Discount Price 8am – 1pm $45 $202.50 8am – 5pm $60 $270