Privacy Moreland City Council acknowledges and respects the privacy of individuals. Personal information collected on your teen’s enrolment form and during that enrolment, including health and sensitive information, is collected, retained and used for the purpose of establishing and maintaining your teen’s enrolment, processing financial payments (via financial institutions) and benefits where applicable. By entering into this agreement, you agree that, to the extent reasonably necessary to enable provision of your teen’s enrolment and in conducting the service, Moreland City Council, its related entities, and their contracted service providers including Federal, State and Local Government Agencies covered by law, may be recipients of such information.You have the right to access personal information protecting yourself in accordance with the Commonwealth Privacy Act (Amended 2001). The Moreland City Council Privacy Policy is available online at www.moreland.vic.gov.au. You may receive communications from the Active Moreland from time to time to update you on matters relating current programs through a variety of means of communication including mail, email, sms and telephone. Service information • • • • • • • The Teenage Holiday Program is open to young people in year 7, 8 and 9 who live or go to school in Moreland. Young people not currently attending school are still eligible to attend. If you have a young person with special needs please contact the service to discuss the needs of your teen and participant. There are a small number of places available for participants with low to moderate additional needs. Active Moreland and staff reserve the right to send unwell children/teenager home. Please ensure your child/teenager arrives at the pick up points at the specified time so that the schedule can be adhered to. Please ensure that you pick up your child/teenager at the time designated for your location. Active Moreland will endeavour to arrive at each location on time but may at times arrive late due to unpredictable traffic issues. Please refer to flyer or www.activemoreland.com.au for pick up locations. What to bring • • • Teenagers should be in suitable clothing for all planned activities and weather conditions. This includes runners, comfortable clothing, hat, sunscreen, jackets and swimming gear for water activities. Active Moreland recommend that participants bring a nutritious lunch, including enough snacks and drink for the day. See program information for details of which days have an option to purchase food. Any food purchased is at an additional cost to the participant. Parents who require medication to be administered to their teen during the program, please bring along medication with instructions for staff, incase administration of medication is needed. Only medication with a pharmacists dispensing label outlining the teen’s name, dosage, name of medication and current date will be administered. Teenage Holiday Program What not to bring • • All Active Moreland Holiday programs are nut free zones. NO peanut butter, nuts or nut products are to be sent with your teen. Please ensure you review all foods that you are providing for your teen. We recommend that no valuable items from home including electronic games and devices, jewellery etc are brought to and used in the program. Active Moreland holds no responsibility for the loss or damage to any such equipment. Step 3: Payment I wish to pay by Cash Credit Card Credit card payments Select Visa / $ Mastercard Card holder’s name Expiry date ChequeAmount to be paid EFTPOS CVV No. Credit card number Card holder’s signature To protect your personal information, this form cannot be emailed, scanned or faxed to the centre, this form must be returned to the centre in person. Step 4: Declarations Step 4: Declarations I, the undersigned approve the enrolment and agree to abide by the rules and conditions of Active Moreland’s Teenage Holiday Program and meet any cost attached hereto. This includes no alcohol or drug possession or consumption, no smoking, no behaviour or actions which risk the health and safety of workers or other participants in the program, and no use of offensive or abusive language directed towards program participants, workers or anyone who comes in contact with the program. In the event of any unforseen accident or illness I authorise the Teenage Holiday Program staff to obtain such medical assistance as is required and agree to meet any expense attached thereto. I hereby authorise my child/teenager to participate in the program. I give permission for photos and/or video to be taken of my child by program staff for the purposes of promotion of the program. Yes No Parent/Guardian name Parent/Guardian signature Date Participant’s signature Date / / / / Payment type Including young people who are not currently attending school Autumn April 1 – April 10 2015 Bookings open now! This section is for office use only Entered on the THP participant database Fun and empowering activities for Year 7, 8 and 9’s Yes No Amount paid $ DateStaff Active Moreland Teenage Holiday Program Booking Form 2015 Confirmed Yes No Come in: Coburg Leisure Centre – Bridges Reserve, Bell St, Coburg, 3058 Fawkner Leisure Centre – 79/83 Jukes Rd, Fawkner, 3060 Brunswick Baths – 14 Dawson St, Brunswick, 3056 P: 03 9354 3504 F: 03 9354 8062 E: [email protected] W: activemoreland.com.au Area Coburg Brunswick Glenroy Fawkner Pick up / drop off times and locations Address Pick-up Drop-off Coburg Leisure Centre Bridges reserve, Bell Street Brunswick Library, Dawson Street, Brunswick on Dawson Street next to the library awning Cnr Hartington St & Glenroy Road across the road from Glenroy Station Fawkner Leisure Centre 79-83 Jukes Road 9am 3pm 8.30am 3.30pm 8.40am 3.30pm 8.50am 3.40pm Week 1 Week 2 Wednesday 1 April Luna Park Tuesday 7 April Fun City and Swimming Option to bring lunch or purchase at own cost. Option to bring lunch or purchase at own cost. Experience Melbourne’s ultimate destination for fun! Unlimitedrides including: The Spider, Enterprise, Ferris Wheel, Twin Dragon and Scenic Railway. Thursday 2 April Movies and Intencity Catch a movie at Reading Cinemas in Epping then head to Intencity for an hour of unlimited video games. Option to bring lunch or purchase at own cost. Go Karts, Laser Force and more at Fun City Sunshine, then to Coburg Leisure Centre for a swim in the heated indoor pool. Bring bathers and a towel. Thursday 9 April Horseriding Trail ride through the beautiful countryside at Uncle Nev’s in Whittlesea. No experience necessary with experienced staff leading the group. Option to bring lunch or purchase at own cost. Friday 10 April YMCA Lake Dewar Excursion Head to YMCA’s Lake Dewar recreation camp for some fun and challenging activities, such as: Canoeing, Flying Fox, Tunnelling and Archery. Activities may vary depending on the weather, but bring a towel and change of clothes just in case. Must bring own lunch. No options to purchase food. General Information: TEENAGERS WITH ADDITIONAL NEEDS Active Moreland welcomes participants with low to moderate additional needs and independent mobility to the program and has a limited number of spaces available for each day. For further information and to discuss the possibility of your teen attending one or more of the days please contact the program coordinator. Please note that acceptance in the program is not guaranteed if the program coordinator is not satisfied that the participant needs can be met. PROGRAM LEADERS Program Leaders are First Aid, CPR and Anaphylaxis trained. All leaders hold a Working with Children Check Card. BOOKINGS Bookings are only accepted once a 2015 enrollment form has been completed, signed and returned with payment details confirmed. Please ensure you have completed ALL sections of the enrollment form making sure you sign and understand the terms and conditions. Bookings are not finalised until full payment has been received. HORSE RIDING WAIVER A seperate waiver form must be completed for the Horse riding activity. This will be available on the Active Moreland website and emailed to you upon booking. PROGRAM SPECIFICS: • This program is offered to Year 7, 8 and 9’s who live or go to school in the Moreland area • Bookings and pre payment are essential to confirm your teen’s place in the Teenage Holiday Program. • Participants will be fully responsible for any valuables they bring to the program. We recommend that participants do not bring any valuables such as electronic devices, jewellery etc that are not necessary for the program. • Please ensure your teen arrives at the pick up points at the specified time so that the schedule can be adhered to. OTHER INFORMATION: Management reserves the right to make changes to the program without notice. This includes cancellation of the program due to insufficient numbers or inclement weather. Teenages are expected to be co-operative, courteous, and respectful towards other participants and leaders, participate in activities, and to respect the environment we are in. We reserve the right to send a teenager home for serious breach of this policy i.e the teenager is endangering the physical or emotional safety of others and/or has persistently failed to respond to discussions regarding unacceptable behaviour. There will be no refunds for young people asked to leave the program. Active Moreland Teenage Holiday Program: Booking Form • Booking An Enrolment Form must be completed for each participant Active Moreland Teenage Holiday Program: Booking Form Forms can be downloaded online at www.activemoreland.com.au or contact (03) 9354 3504 or email Booking Forms can be downloaded online atavailable at each centre [email protected]. Forms www.activemoreland.com.au or contact (03) as 9354 or email Please book early to avoid disappointment we 3504 are limited [email protected]. Forms also available in the amount of places we can offer. This booking will notatbe each centre.until Enrolment and Booking Forms are completed, confirmed • Please book early to avoid we are limited submitted and a place hasdisappointment been allocated.as A waiting list will be intaken the amount places we can offer. This booking will not be for eachofday in case of cancellations. • confirmed Enrolment are completed, If a place until is allocated, youand willBooking receive aForms confirmation of booking submitted full payment has been received. (once full and payment is received) via email. If you do not receive • Once paymentplease is processed booking is confirmed, if youor confirmation, contactyour Chris Arena on, 03 9354 3504 are unsure of this, please contact Chris Arenaallow on, 03 9354 3504 [email protected]. Please 2 working days or [email protected]. before making contact once you have submitted your form. •• Please Pleasenote noterefunds refundswill willnot notbe beissued issuedfor forabsent absentdays daysdue duetoto sickness sicknessor orany anyother otherreason. reason. and returned to Active Moreland prior to the booking form being able Form must be completed for each participant toAn beEnrolment accepted and processed. and returned to Active Moreland prior to the booking form being able to be accepted and processed. Details to return the form are: Details to return the form are: Email: [email protected] Email: [email protected] Fax: Fax:03 039354 93548062 8062 Post: Post:Coburg CoburgLeisure LeisureCentre, Centre,Bridges BridgesReserve, Reserve,Bell BellSt, St,Coburg, Coburg,3058 3058 • • Hand Handininatatone oneof ofthe theActive ActiveMoreland MorelandLeisure LeisureCentres: Centres: CoburgLeisure LeisureCentre Centre––as asabove above Coburg FawknerLeisure LeisureCentre Centre––79-83 79-83Jukes JukesRd, Rd,Fawkner, Fawkner,3060 3060or or Fawkner BrunswickBaths Baths––14 14Dawson DawsonSt, St,Brunswick, Brunswick,3056 3056 Brunswick How to Book Step 1: Personal Information How to Book Step 1: Personal Information Parent/Guardian Name Contact Number Parent/Guardian Name Contact Number Address Suburb Postcode Address Suburb Postcode Email Teen’s School Email Teen’s School Teen’s Full Name DOB / / M Teen’s Full Name DOB / / M Second Emergency Contact Name Contact Number Second Emergency Contact Name Contact Number Teen’s medical details: Does the particpant have any illness, condition or disability? (attach details) Teen’s medical details: Does the particpant have any illness, condition or disability? (attach details) F F Is the participant currently taking any medication? (please specify) Is the participant currently taking any medication? (please specify) Is medication assistance required? Yes No Is medication assistance required? Yes No Does the participant have any allergies (including medications)? (please list) Does the participant have any allergies (including medications)? (please list) General permissions • Can the participant swim? Yes Are there any details not included in this form that may be important for a person who supervises this young person to know? • I give permission for this young person General permissions • Are there any details not included in this form that may be to see movies that are “M’ rated: Yes No • Can the participant swim? Yes Poor Not at all important for a person who supervises this young person • I give permission for this young person to depart from the to*know? Please advise the program coordinator if there are any • I give permission for this young person drop off point unsupervised after the program is over:* known persons who this young person should NOT be to see movies that are “M’ rated: Yes No released into the care of. Yes No • I give permission for this young person to depart from the * Please advise the program coordinator if there are any drop off point unsupervised after the program is over:* known persons who this young person should NOT be released into the care Step days would your teen attend? (Please select which days of. you would like your teen booked in.) Yes 2: Which No Week 1 Poor • Not at all Thursday 10 - Wednesday 16 April Thurs 10 April Fri 11 April Mon 14 April Tues 15 April Wed 16 April Step Which daysHorseriding would your teen attend? select which days you would like your teen booked in.) Movies &(Please Bowling Luna2:Park Outdoor Action Kemizo & Swim Cost $ 30 Cost $ 45 Cost $ 20 Cost $ 20 Cost $ 25 Wednesday 1GAprilF – Friday 10 C B C B April G Wed 1 April Thurs 2 April Week 2 Luna Park C B Cost $ 20 Movies and Intencity C B G G Total cost $ Total cost $ F F Cost $20 C B Cost $ 20 C B C B G F Tues 7 April F G F Cost $32 C B Cost $ 25 C B B G F G Cost $45 C B Cost $ 25 B G F Lake Dewar YMCA Tues 21 Jan F C Fri 10 April Horse riding Wed 16 April G C Thurs 9 April Fun City and Swim Tues 15 April Mon 14 April Cost $30 F Wed 22 Jan G F Cost $25 C Cost $ B 20 G F G F C B G F C B G F Pick up locations C: Coburg B: Brunswick G: Glenroy F: Fawkner Refer to brochure for pick up location addresses. Pick up locations C: Coburg B: Brunswick G: Glenroy F: Fawkner Refer to brochure for pick up location addresses.
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