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* 1. Parent name:

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* 2. Parent phone number:

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* 3. Child 1 name:

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* 4. Child 2 name:

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* 5. Emergency contact 1 name:

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* 6. Emergency contact 1 phone:

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* 7. Emergency contact 2 name:

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* 8. Emergency contact 1 phone:

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* 9. Toolamba OHSC School Holiday Program:

Dates of excursions for answers below:

23/9/2025 - Riverside Gardens Mini Golf, Chocolate Factory, Shepparton Lake
25/9/2025 - Fun Planet, Aquamoves, All Abilities Playground
30/9/2025 - Rebound, Village Cinemas
2/10/2025 - Mansfield Zoo

Educators:

OHSC Mobile number 0490 812 401

Sarah Maskell

Rhiannan Duffy

Emily Keady

Abby Knight

Maximum number of children: 27.
Ratios are maximum of 1:11 as required by ACEQUA and QARD. Risk Assessments have been completed.

Seatbelts will be worn where buses are fitted. Jacobson's Bus Lines and Ford's Shepparton will be our mode of transport.

Departure times are listed on the School Holiday Program: Important Information sheet.

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* 10. I consent for my child to participate in above activities for the applicable days my child/ren are booked on Xplor, and be charged the additional costs as detailed on the School Holiday Program Planner.

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* 11. I consent for my child to participate in above activities and travel by bus to the planned locations.

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* 12. I consent for my child to leave the grounds for the purpose of supervised walks to community areas such as Colaura Gardens, Daunts Bend, Community Oval.

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* 13. Do you consent for the service to seek medical treatment for your child from a medical practitioner, hospital or ambulance, including travel in an ambulance, in the event you cannot be contacted?

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* 14. Do you give permission for educators with current first aid to administer paracetamol in an emergency in the correct dosage for the age of your child/ren?
**Administration of medication will only be given in the event of a parent being un-contactable in consultation with the director or nominated supervisor.

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* 15. Parent signature:

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* 16. I acknowledge that by entering my name above I am providing a digital signature.

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* 17. Date:

Date

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