3. ENROLMENT FORM

ENROLMENT - KELMSCOTT HOMESCHOOL GROUP - TERM 4, 2019 (KELMSCOTT HALL) 28 Oct, 4 Nov, 25 Nov, 2 Dec, 9 Dec, 16 Dec

* 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 *

Child 2 - name *

First

Last

Child 2 - age *

Child 2 - additional needs or allergies *

Child 3 - name *

First

Last

Child 3 - age *

Child 4 - name *

First

Last

Child 4 - age *

Child 4 - additional needs or allergies *

Do you have HEWA/HBLN membership? *

YES NO - I understand that my fees will have a 20% surcharge and must choose the Non-HEWA option on the group fee and classes

HEWA/HBLN membership number *

HEWA/HBLN membership expiry date *

**Update 4 July. HBLN insurance: The annual insurance is now part of full/concession HBLN membership and will no longer need be paid separately. Those of you who have paid the annual insurance levy will be reimbursed by HBLN**

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 *

09:20-09:35: Assist in setting up 13:45-14:15: Assist in packing up/cleaning up of the main hall 14:30-14:45 Assist in packing up/cleaning up of lesser hall First Aid officer KHG Committee member (minimum commitment 2 terms); 2 meetings per term, some email contact, assist the coordinator on the Mondays (greet families, answer basic enquiries, assist during evacuation drills)

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

Please make sure you head to 4. Pay to add the HALL HIRE CONTRIBUTION to your order as well as any classes