Thanks for your interest in the upcoming FREE Breakaway Holiday Programme. There are heaps of fun activities planned – something different every day – so you’re in for an awesome time! You bring your water bottle and lunch every day, and we’ll provide the fun!

Now, just fill out the form below, hit send, and we’ll be in touch soon to confirm your registration.

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* 1. Participant's Details

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* 2. Gender

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* 3. Ethnicity

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* 4. Age

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* 5. List any medical conditions (and medications you are taking), behavioural/learning difficulties we should be aware of

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* 6. Parent/Caregiver/Emergency Contact #1

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* 7. Parent/Caregiver/Emergency Contact #2

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* 8. Book my child for these days.

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* 9. Do you give permission for your child to be transported to/from activities in YMCA vehicles?

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* 10. Do you give permission for your child's photo to be used on future YMCA promotional material?

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* 11. I hereby give permission for my child to participate in all YMCA Breakaway Holiday Programme activities.

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* 12. How did you find out about us?

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