3. ENROLMENT FORM (ROUND 2)

ROUND 2 (vacancies)

ENROLMENT FORM- KELMSCOTT HOMESCHOOL GROUP - TERM 4, 2021

ROSSITER PAVILION
25 Oct, 1 Nov, 8 Nov, 15 Nov, 22 Nov, 29 Nov

KHG is registered with Home Education WA/Home Base Learning Network (HEWA/HBLN). Insurance is included in membership fees. Non-HBLN families will incur a 20% levy on all KHG fees towards the cost of insurance.
Hall hire contribution is payable by all families: $40/family/term HBLN or $48/term/family/non-HBLN
Cost of classes is per student.

* Indicates required field

Parent/guardian Name *

First

Last

Parent/guardian Email *

Parent/guardian phone number(s) *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Emergency contact (other than yourself) *

First

Last

Emergency contact's phone number(s) *

Person authorised to bring your child/ren and be responsible for them at Kelmscott Homeschool Group *

First

Last

Authorised Person 1's Phone number *

Person authorised to bring my child/ren and have responsibilty for them whilst at Kelmscott Homeschool Group *

First

Last

Authorised person 2's phone number *

Please include all children who will accompany you to Kelmscott Homeschool Group.

Child 1 - name *

First

Last

Child 1 - age *

Child 1 - additional needs or allergies *

This child needs a parent/carer present in classes *

YES NO

Child 2 - name *

First

Last

Child 2 - age *

Child 2 - additional needs or allergies *

This child needs a parent/carer present in classes *

YES NO

Child 3 - name *

First

Last

Child 3 - age *

Child 3 - additional needs or allergies *

This child needs a parent/carer present in classes *

YES NO

Child 4 - name *

First

Last

Child 4 - age *

Child 4 - additional needs or allergies *

This child needs a parent/carer present in classes *

YES NO

Please complete an additional form if you have more than 4 children attend Kelmscott Homeschool Group with you. Thank you

HOME EDUCATION WA (HEWA/HBLN) MEMBERSHIP

Do you have HEWA/HBLN membership? (Includes insurance) *

YES NO - I understand that my fees will have a 20% surcharge and must choose the Non-HBLN option on the hall hire contribution and classes

HEWA/HBLN membership number *

HEWA/HBLN membership expiry date *

PHOTOGRAPHY AND VIDEO RELEASE

The Organiser takes photos of the group in action to include in the end of Term newsletter and on in some instances for inclusion in Home Education WA (HEWA/HBLN publications). If you do not wish for your children to be photographed, please let the Organiser know.

You may take photographs of your own family for personal use. You must seek permission from other parents if you would like to take photos that include their family prior to taking photos.

Please tick which applies *

I give permission for Kelmscott Homeschool Group and HBLN/HEWA to use photography/video of myself or child(ren) for KHG's or HBLN/HEWA’s newsletter or other printed materials. I give permission for Kelmscott Homeschool Group and HBLN/HEWA to use photography/video of myself or child(ren) for KHG's or HEWA/HBLN’s social networking sites, the members section of the HEWA/HBLN website and at other HEWA/HBLN organised events. I give permission for Kelmscott Homeschool Group and HBLN/HEWA to use photography and/or video of myself and/or children in BOTH digital and printed formats I DO NOT give permission for Kelmscott Homeschool Group or HBLN/HEWAto use photography/video of myself and/or children

ASSISTANCE IS NEEDED TO ENSURE THE SMOOTH RUNNING OF THE GROUP

Assistance I can give to the Kelmscott Homeschool Group on a weekly basis *

09:00-09:20 SETTING UP & CLEANING BEFORE FIRST CLASSES 1215-1245 or 1330-1400 CLEANING UP AT END OF THE DAY SUPERVISION AT THE SIGN IN DESK (SIGNING, SANITISING/HAND WASHING PROMPT) COVID-19 COMPLIANCE ASSISTANCE (HAND SANITISING/HANDWASHING PROMPTS) FIRST AID - PLEASE EMAIL COPY OF CURRENT CERTIFICATE

MEMBERSHIP AGREEMENT AND FORM SUBMISSION

MEMBERSHIP AGREEMENT *

I understand that Kelmscott Homeschool Group is NOT a "drop and run" service. Parents/Guardians are responsible for the supervision of their child(ren) at all times. Parents/guardians or another authorised person must remain on site at all times. I understand that HBLN/HEWA, Kelmscott Homeschool Group, its members, volunteers, and parent organisers, cannot be held liable for any accidents or injuries sustained by my child(ren) in the normal course of activities, provided that all due care has been taken. I understand that an organiser of Kelmscott Homeschool Group will call an ambulance in my absence if it is deemed necessary for the wellbeing of my child, and I agree to pay any and all costs involved. I understand that is is my full responsibility to advise organisers via email of any and all changes to my personal information as it changes. I have read through the Welcome pack (membership agreement) and policies and agree to the terms and conditons of these documents.

(2. Read) Welcome pack (membership agreement) and policies

Submit

Thank you. Please head to PAY or request an invoice via email khg.coordinator@gmail.com if preferred.