Holiday Program Booking Form : Canberra Montessori School

1. Name of Parent/Carer (Surname/Given Name): *

1. Phone Number *

2. Name of Parent/Carer (Surname/Given Name):

2. Phone Number

Your Email Address *

Name of child/ren (Surname/Given Name): *

Attending the following class/es: *

Please nominate your preferred option: *

Full time (full days - 17/12/18 - 30/1/19) 8:30am - 6:00pm @ $80 per day

Full time (full days - 17/12/18 - 30/1/19) 7:30am-6:00pm @ $89 per day

Part time (full day) 8:30am-6:00pm @ $80 per day - please nominate days below

Part time (full day) 7:30am-6:00pm @ $89 per day - Please nominate days below

Week 1

Monday 17/12/18 (Salt Dough, Christmas Movie, Popcorn)

Tuesday 18/12/18 (Board Games) + Petting Zoo $15

Wednesday 19/12/18 (Wheels Day) + Reptile Zoo $5

Thursday 20/12/18 (Coconut Ice Slice) + Bouncy Castle $17

Friday 21/12/18 (Craft and Movie)

Week 2

Wednesday 2/1/19 (Board Game and Movie)

Thursday 3/1/19 (Soap making and craft)

Friday 4/1/19 (Wheels day and Pancakes)+ Gymnastics $8

Week 3

Monday 7/1/19 (Wheels) + Chicks $5

Tuesday 8/1/19 (Playdough and Kites)

Wednesday 9/1/19 (Cooking and Movie)

Thursday 10/1/19 (Face Painting) Bouncy Castle + $17

Friday 11/1/19 (Wheels day) + Gymnastics $8

Week 4

Monday 14/1/19 (Papier Mache and Wheels) + Chicks $5

Tuesday 15/1/19 (Paper craft and Banana bread)

Wednesday 16/1/19 (Water Tattoos) + Puppet Show $13.50

Thursday 17/1/19 (Face Painting ) + Bouncy Castle $17

Friday 18/1/19 (Wheels day) + Gymnastics $8

Week 5

Monday 21/1/19 (BBQ, Wheels and Disco)

Tuesday 22/1/19 (Pancakes) Traditional Animals + $18

Wednesday 23/1/19 (Marbling and Movie)

Thursday 24/1/19 Bouncy Castle and Balloon Animals + $17

Friday 25/1/19 (Wheels day) + Gymnastics $8

Week 6 - Wednesday 30/1/19 FULLY BOOKED

Tuesday 29/1/19 (Board games and Wheels)

Please Note:

Does your child have any allergies or other health issues? *

Yes - an Emergency Treatment Plan must be provided

No

If Yes: Details of allergies/health issues

Permission *

I give permission for my child to attend the activities on the days I have indicated above and to pay the extra cost as shown. I have read and understood the program information distributed and understand that risk assessments are available from the office.

Do you wish to receive your invoice by email? *

Yes

No

Signature *

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Date *

Dogs ACT

Holiday Program Booking Form