Ckids Afterschool Club for the Northern Beaches will run in 2026 on a Wednesday during school term. The program will run out of a location in Narrabeen (to be provided after enroling) and will go from 3:30-5:00pm. The cost of the program is $22/week. How many children would you like to enrol* 123 CHILD 1 CHILD INFORMATION Full Name* First Name Last Name School Attending School Year (2026)* Year KYear 1Year 2Year 3Year 4Year 5Year 6Year 7 AUTHORISATION I agree that if my child has been injured, or becomes ill whilst at the service or otherwise in care, for the approved provider, a nominated supervisor or an educator to seek: Medical treatment for the child from a registered medical practitioner, hospital or ambulance service and transportation of the child by an ambulance service* YESNO I give consent to the carrying out of appropriate medical, dental or hospital treatment* YESNO Does your child have any special considerations we need to take into account for their enrolment?* YESNO If Yes, please advise of the special considerations. MEDICAL CONDITION & DIETARY RESTRICTION Does your child have any medical management plan, anaphylaxis medical management plan or risk minimisation plan with respect to the child's healthcare need, medical condition or allergy?* YESNO If yes, you MUST email a colour copy of your child’s Action Plan to chanie@chabadhouse.org.au and ensure they bring their medication on each day. Does your child have a diagnosed disability?* YESNO If Yes, please advise of the diagnosed disability. ADDITIONAL INFORMATION Please provide any information you feel the service should know about the child e.g. language, religion, court orders, additional needs etc. CHILD 2 CHILD INFORMATION Full Name* First Name Last Name School Attending School Year (2026)* Year KYear 1Year 2Year 3Year 4Year 5Year 6Year 7 AUTHORISATION I agree that if my child has been injured, or becomes ill whilst at the service or otherwise in care, for the approved provider, a nominated supervisor or an educator to seek: Medical treatment for the child from a registered medical practitioner, hospital or ambulance service and transportation of the child by an ambulance service* YESNO I give consent to the carrying out of appropriate medical, dental or hospital treatment* YESNO Does your child have any special considerations we need to take into account for their enrolment?* YESNO If Yes, please advise of the special considerations. MEDICAL CONDITION & DIETARY RESTRICTION Does your child have any medical management plan, anaphylaxis medical management plan or risk minimisation plan with respect to the child's healthcare need, medical condition or allergy?* YESNO If yes, you MUST email a colour copy of your child’s Action Plan to chanie@chabadhouse.org.au and ensure they bring their medication on each day. Does your child have a diagnosed disability?* YESNO If Yes, please advise of the diagnosed disability. ADDITIONAL INFORMATION Please provide any information you feel the service should know about the child e.g. language, religion, court orders, additional needs etc. CHILD 3 CHILD INFORMATION Full Name* First Name Last Name School Attending School Year (2026)* Year KYear 1Year 2Year 3Year 4Year 5Year 6Year 7 AUTHORISATION I agree that if my child has been injured, or becomes ill whilst at the service or otherwise in care, for the approved provider, a nominated supervisor or an educator to seek: Medical treatment for the child from a registered medical practitioner, hospital or ambulance service and transportation of the child by an ambulance service* YESNO I give consent to the carrying out of appropriate medical, dental or hospital treatment* YESNO Does your child have any special considerations we need to take into account for their enrolment?* YESNO If Yes, please advise of the special considerations. MEDICAL CONDITION & DIETARY RESTRICTION Does your child have any medical management plan, anaphylaxis medical management plan or risk minimisation plan with respect to the child's healthcare need, medical condition or allergy?* YESNO If yes, you MUST email a colour copy of your child’s Action Plan to chanie@chabadhouse.org.au and ensure they bring their medication on each day. Does your child have a diagnosed disability?* YESNO If Yes, please advise of the diagnosed disability. ADDITIONAL INFORMATION Please provide any information you feel the service should know about the child e.g. language, religion, court orders, additional needs etc. PARENTS/GUARDIAN DETAILS PRIMARY PARENT/GUARDIAN(This person's details are used to claim government subsidy) Full Name* First Name Last Name Relation to child* E-mail * Phone (Mobile)* Address* Street Address Street Address Line 2 City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country ADDITIONAL/EMERGENCY CONTACTS Please enter additional contacts for this enrolment. This may include emergency contacts when you are unavailable to be contacted in the case of an emergency. This is not required, only fill in if you would like to add over and above the previous enrolment. ADDITIONAL/EMERGENCY CONTACT Full Name* First Name Last Name Relation to child* Phone (Mobile)* Enrolment Agreement By signing below, I confirm, I indemnify Chabad North Shore against responsibility for any accident, loss or injury suffered by my child/ren during the course of the activities. I expressly release Chabad North Shore, its employees or officers from any claim or liability arising directly or indirectly from the enrolled program. That my child will be photographed and videoed for the purposes of recording the wonderful services we offer, and sharing this information with our parent-body, and for encouraging the attendance of others within our community. If you specifically do not want pictures of video clips of your child/ren shared, please contact Chanie Schapiro - chanie@chabadhouse.org.au to discuss. Sign by filling-in your full Legal Name* Payment Information A deposit of $100 per child is taken within 2 days of confirmation of this enrolment. The money will go towards the next term's fees. Payment is charged based on the payment plans you choose below. Payment Options* Pay in full today for 2026Pay by term, at the first Monday of each termPay by half term, at the first and fifth Monday of each term Payment Method* Credit Card (Surcharge of 1.1% Mastercard, 1.5% Visa and 2% Amex)Direct Debit Credit Card We accept Visa, MasterCard, American Express Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2026202720282029203020312032203320342035 Expiration Year Account Name BSB Account Number Submit Should be Empty: This page uses TLS encryption to keep your data secure.
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