YMCA GEELONG SCHOOL HOLIDAY PROGRAMBooking Form

Child 1  (type here) Child 2  (type here)  ALL CHILDREN

Child 3  (type here)  Approximate drop off time  (type here)  AM

Child 4  (type here)  Approximate pick up time  (type here)  PM

Please tick the boxes below corresponding to the days that you wish your child/ren to attend.Important note –Applying Child Care Benefit, Child Care Rebate or JET will reduce the daily fees as outlined. Please visit our website, www.geelong.ymca.org.au to view the ready reckoner to assist you with understanding your daily fees. To claim CCB, CCR or JET you must be registered with the Family Assistance Office (Centrelink).

Additional notes (if additional needs children are booked on excursion days, please indicate here if you request for the child/ren to remain at centre)

 (type here )  

THIS BOOKING FORM MUST BE SUBMITTED BY FRIDAY MARCH 18 th , 2016

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Week Monday Tuesday Wednesday Thursday Friday

1 March 29

EASTER MONDAY

PUBLIC HOLIDAY

March 29

School Holiday Program$60 per child

March 30

School Holiday Program – excursion daySUPATRAMP$85 per child

March 31

School Holiday Program$60 per child

OR

Junior Adventure Camp $85 per childBooking for (please circle):

ALL, Child 1, Child 2, Child 3, Child 4

April 1

School Holiday Program – excursion day1. INFLATABLE WORLD2. ‘THE PARK’ SKATE PARK

$85 per child

OR

Junior Adventure Camp $85 per childBooking for (please circle):

ALL, Child 1, Child 2, Child 3, Child 4

2 April 4

School Holiday Program $60 per child

OR

Senior Adventure Camp $85 per childBooking for (please circle):

ALL, Child 1, Child 2, Child 3, Child 4

April 5

School Holiday Program $60 per child

OR

Senior Adventure Camp $85 per childBooking for (please circle):

ALL, Child 1, Child 2, Child 3, Child 4

April 6

School Holiday Program – excursion dayTIMEZONE $85 per child

April 7

School Holiday Program$60 per child

April 8

School Holiday Program – excursion daySOVEREIGN HILL$85 per child

REGISTRATION & BOOKINGRegistration and booking forms may be submitted in person, via fax, or scan/email. Word Document versions of forms are available for the ease of customers. Please visit www.geelong.ymca.org.au or come see us at our Newtown Stadium venue.It is not recommended to submit forms via the post as these may not be received by the closing date. Once all forms and supporting documentation has been received families will receive an invoice statement detailing fees owed and days requested for booking. Fees are an ESTIMATE only. Bookings are tentative until payment in full has been received (except where National Disability Insurance Agency funding applies). Should the program be booked out, families will receive notification from the Community Programs Coordinator. We will soon be transitioning to new software which will allow families to register, book and pay online! This system is still being processed but we hope to have it functional very soon. Throughout this transition please continue to use the regular booking/registration forms. Families will be notified once the new software is active and ready to be accessed.

CONFIRMATION & PAYMENT OF FEESPayment must be made in full prior to the commencement of the program. Families will receive an invoice statement as tentative confirmation of booking. Once payment has been received, bookings are then confirmed. Please note that fees outlined on the initial statement are estimates only. A calculated invoice is provided at the conclusion of each program and may indicate a variance in fees based on Child Care Benefit entitlements. Any children funded by the National Disability Insurance Agency (NDIA) are not required to make payment upfront as fee claims are submitted at the conclusion of the program. Fees can be paid via internet banking (please see invoice for bank details), in person or via credit card over the phone. We are soon transitioning all payments to occur via direct debit. Families will nominate an account or credit card which will be deducted at the time that bookings are confirmed. If any refunds are required families will be notified through the issue of statements and the refund (where applicable) will be credited to the nominated account/credit card. Families can access a ready reckoner from our website to determine their fees at the applicable reduced rate based on individual child care benefit entitlements. Please allow up to 7 working days for your booking to be processed. If you haven’t received your confirmation invoice after this time please contact the centre.

Is your child funded to attend YMCA Geelong School holiday Program through NDIS (National Disability Insurance Scheme)? Yes NoDo you give permission for YMCA Geelong to submit the full amount to be paid by NDIS? Yes No

If no, please indicate here the approved amount & hours for NDIS payment:  (type here) Please note that NDIS funding cannot be applied for by the service until the conclusion of each program, therefore families should note that the balance will be an outstanding amount until authorised and submitted.

Should families be suffering from significant financial difficulty and are unable to meet the requirements of the current fee schedule, I urge you to contact the Coordinator of the program immediately via email or phone: Kimberley Maher: kimberley.maher@ymca.org.au OR 5223 2714

CANCELLATIONSYMCA Geelong requires all cancellations in writing and with at least 7 days’ notice to the beginning of the program. All cancellations requested by this time will be refunded for the day/s cancelled. If your cancellation occurs after this period a refund will only be issued if a medical certificate is submitted.

CHECKLISTHave I provided YMCA Geelong School Holiday Program with the following?: Up to date registration information N/A Yes No Customer Reference Numbers and dates of birth for all family members N/A Yes No Behaviour Management Plans N/A Yes No Signed booking form N/A Yes No Asthma/Allergy/Anaphylaxis Management Plans N/A Yes No Risk Minimisation Plans N/A Yes No Medication Authorisation Form N/A Yes No All three Inclusion Subsidy Support Forms N/A Yes No Direct Debit Form N/A Yes No

DECLARATIONI hereby understand that by making a booking I am committing my child/ren to attend on the days listed above. This in turn provides management with accurate information of attendance, which enables the appropriate ratio of staff to be employed. I will ensure that I adhere to the cancellation policy should I need to cancel any days initially booked. I acknowledge that failure to give notice as per the cancellation policy or without a medical certificate will not entitle me to a refund of fees paid. I acknowledge that with the exception of Nation Disability Insurance Scheme funding, I am required to make full payment prior to the commencement of the school holiday program and bookings for my child/ren will not be confirmed until payment has been made.

Print name  (type here)  Date  (type here) 

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