Full Name
Date of Birth
Siblings who reside with child (biological/otherwise)
Shirt Size 46810
Name
Email
Full Address
Home Number
Mobile Number
Emergency Contact Name
Emergency Contact Phone
Foster Agency Name
Foster Agency Phone/Email
Child Safety Service Center
Child Safety Officer Name
Current Order (preference for children on Long term guardianship/second short term custody order who can remain with the program for up to 2 years)
Attach a copy of the Protection Order (if possible)
Current Contact Arrangements with Biological Parents (Supervised/Unsupervised)
Foster Agency Details (if relevant, Name/Centre/Contact details)
School/Kindy/Prep/Day Care Details (if relevant, Name/Centre/Contact details)
Therapist Details (if relevant, Name/Centre/Contact details)
Where did you hear about Little Stars Kids Camps? Social MediaWord of MouthMagazine / AdvertisingOther - fill in details below
When children are enrolled we like children to attend all 4 camps per year.
Please Tick 24 February 201919 May 201911 August 20191 December 2019
Will the child be in your care on the above mentioned camp dates? YesNo
It is important that Little Stars Kids Camps has up to date information about your child’s health, so that in the unlikely case of injury/illness we are able to provide the most appropriate medical care. You are required to advise Little Stars Kids Camps if the status of the child’s health changes after completing this form, or your child comes into contact with an infectious disease, (including chicken pox, conjunctivitis, gastro or influenza within TWO weeks of the program.) Children cannot attend camp if they have an infectious condition.
Dietary requirements (e.g. gluten free, lactose free, vegetarian etc)
Does your child have any specific issues surrounding food that would be helpful for our team to be aware of?
Diagnosed illnesses (e.g. post-traumatic stress disorder, autism, etc)
Allergies, sensitivities or reactions (e.g. asthma, bee stings, nuts, grass, hay fever etc)
Does the child have an epi pen? YesNo
Does the child use an asthma puffer? YesNo
Any pre-existing physical injuries/illnesses/ailments?
Any recent surgery?
Are there any physical, social or psychological ailments that may affect the child’s participation in an activity? (e.g. claustrophobia, fear of heights etc)
Is the child toilet trained? YesNo
Does the child require nappies/pull ups? YesNo
What (if any) assistance will the child need with toileting?
Special instructions regarding toileting
Name on Card
Medicare Number
Do you have any other children in your care?
Does the child have siblings not in your care?
Would the child prefer a male or female adult companion for the camps? MaleFemaleNo preference
Does your child have any particular triggers which may impact upon their behaviour/psychological or emotional state that we need to be aware of?
Do you have a behaviour management plan in place? Please set out details of any behaviour management plan which will assist us in caring for the child during the camp:
Do you give permission for photos to be taken of your child during camp (to be included in the child’s photo book and hand-made photo frame at the end of the day and provided to the child): YesNo
It helps us to know a bit about your child so we can personalise the camp experience. Do you have any further information you would like to share about the child applying to attend camp?
Little Stars Kids collects your personal information to administer our programs, including complying with our legal obligations and to allow our companions to get to know the camper better. We also may collect your personal information to promote and communicate with you about our initiatives. If you do not provide the information requested you will not be considered for a position as a camper. We may disclose where necessary, limited personal information to third parties that provide services to Little Stars Kids. We may also disclose your personal information to companions to enable them to get to know the child.
