Term 4 pupil free day 13/10/2025

Pupil Free Fun Day

Monday 13th October
Drop off from 8.30am. 189 Church Street Newtown

Movie from 3pm

$20 per child/ $35 family
Child's Name (1)*

First NameLast Name
Date of birth*

DayMonthYear
Date
Age*
Child's Name (2)

First NameLast Name
Date of birth

DayMonthYear
Date
Age
Child's Name (3)

First NameLast Name
Date of birth

DayMonthYear
Date
Age
Child's Name (4)

First NameLast Name
Date of birth

DayMonthYear
Date
Age
Do any children have any allergies?*

YesNo
Please provide allergy details including child's name*
If no allergy - add NONE
Does this child have any medical conditions you would like to declare?*

YesNo
Please provide relevant medical details including child's name and special instructions.*
If no medical conditions - add NONE
Permission for photos to be used in church promo material*

YesNo
Parent/guardian name*

First NameLast Name
Relationship to child/ren*
Phone Number*
Please enter a phone number you are able to be contacted on during the day on 30/01/2023.
Email*
example@example.com
I give permission for my child to attend the Pupil Free Day, unless I advise the leaders otherwise.
I authorise the Kids leaders, in the event of an emergency, to obtain at my expense any medical, ambulance, rescue or other services that are considered necessary for my child.
I acknowledge that being part of a community involves mutual care and consideration, and therefore agree that unacceptable behaviour may result in my child being sent home and being temporarily or permanently prohibited from attending the activities of the Pupil Free Day.
I will provide the Pupil Free Day leaders with any information relevant to the wellbeing of my child prior to him or her attending this activity.
I confirm that the information given in this form is true and correct, and will advise Leaders of any changes to this information..
Parent/Guardian Signature*

Clear
Date signed*

DayMonthYear
Date

My Products*

Pupil Free Fun Day - family pass

$35.00AUD Quantity

Pupil Free Fun Day

$20.00AUD Quantity

Total

$0.00AUD

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