214B Hibiscus Coast Highway
​09 4265570
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2022 Exhibitions
Child enrolment & permission form
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Indicates required field
Parent / Caregiver's details
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First
Last
Contact Number
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Email
*
Address
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Emergency Contact
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First
Last
Contact Number
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Relationship to child
*
Are you a currently EAC member?
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Yes
No
I dont know, please check
If you are not currently a member but would like to know more about becoming a member please
click here
Child's details
Please complete below for all children in your care who are students of the EAC.
Child's Name (1)
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First
Last
Age
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Date of Birth
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Child's Name (2)
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First
Last
Age
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Date of Birth
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Classes they wish to enrol in
Class code
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Class code
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Class Code
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Students name
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Students name
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Students name
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Price
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Price
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Price
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Payment options (Choose one)
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Direct Bank Payment (Use reference fields - class code & surname) Pay to Estuary Arts Charitable Trust 12-3046-0388526-01
Pay in person at the Centre
Payment must be received prior to commencement of class to secure enrolment.
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Total amount to pay
*
Photo permission
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Yes
No
From time to time we take photos during art activities. We would like your permission to use these photos on our website, in the newsletter, print advertising and/or on our Facebook page. We will never reference you/your child by name or provide any specific information regarding your child. Images will only be used for the promotion of Estuary Art Centres classes and activities.
Dependents Medical Information
Please advise us if your child has any medical conditions or special learning needs so tutor can be made aware of this. All such information will remain confidential.
Medical Condition/Special Needs
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Please advise us if your child has any medical conditions or special learning needs so tutor can be made aware of this. All such information will remain confidential.
Treatment/Stratergies
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Medical Authority
NOTE: Most of EACT staff and tutors are Certified First Aid-ers.
I give my permission to disclose this information to appropriate staff.
In event of emergency I consent to any incurred costs (i.e.: non accident ambulance).
In the event of a medical emergency, should I be unable to be contacted, I authorise the Estuary Arts Centre staff or designated parent volunteer to act in loco parentis and take whatever action they, in consultation with emergency services, deem appropriate in the circumstances.
Click here to view our General
Terms and Conditions
I have read the EAC T&C's
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I agree to the above terms and conditions
I agree to receiving marketing and promotional materials
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