Booking Form: After School Art Club

Artistic Program
Past

Join Campbelltown Arts Centre educators and local artists for Term 3 art club workshops after school.

These creative and educational art workshops will be run on-site at Ruse Public School and Cawdor Public School each week, for children K-6.

Please note: Ruse Public School is booked out. Please email Samantha Relihan via the contact details below to be added to a waitlist.

Campbelltown Arts Centre is a cultural facility of Campbelltown City Council.

These programs are offered as part of Department of Education’s School Hours Pilot.

Contact
Samantha Relihan
Acting Education Officer
[email protected]

Student Details

First Name*

Surname*

Date of Birth*

Home Address

Street AddressStreet Address Line 2CityState / Province / RegionPostal / Zip CodeCountry

School

Is the student an Aboriginal and Torres Strait Islander descendent?

Yes

What is the student’s cultural background?

Location (Please note registered students will be booked for all 8 sessions at the chosen location)

Cawdor (8 weeks,Wednesdays 26 July – 13 September 2023, 3.15pm – 4.30pm)

Parent/Carer Contact Information

First Name *

Surname *

Mobile Phone*

Area Code

Phone Number

Home or Work Phone*

Area Code

Phone Number

Email*

Authorised people to collect
In addition to ‘Parent 1’, the following people are authorized to collect my child from this workshop

Person 2

Name

Relationship to child

Phone Number

Area Code

Phone Number

Custody arrangements

Please give details if there are family court orders we should be aware of. This may include information relating to who is authorized to collect your child/ren, AVOs or otherwise.

Emergency, Health & Safety Details

Emergency contact person

Name *

Phone *

Area Code

Phone Number

Relationship to child

Health, Medical & Support Information

Please include any allergies or medical conditions and their treatment (for the purposes of this program).
Please include any diagnoses, disability or access needs that might affect your child’s participation in the program.
Please provide any information on concerns, recommended routines or best ways to support your child.
Any other comments or requests.

Acknowledgments

I have read and agree to the following…

Yes

Campbelltown Arts Centre cannot administer medication, including Panadol or regular asthma medication

Campbelltown Arts Centre do not have an Epipen/auto-injector, or Asthma medication in our first aid kit

Please pack drinks and/or snacks for your child/ren. C-A-C isn’t able to provide this.

Parent / carer must contact C-A-C to advise if their child is absent.

Parent/carer must contact C-A-C before 3pm, if child/ren are being collected by someone not on above authorized list.

Campbelltown Arts Centre will collect children from teacher supervision. You child/ren must be collected by an authorized parent/carer. Campbelltown Arts Centre staff will ask parent/carer to ‘sign out’ children at the collection point.

Please speak to the school or contact us if you would like to discuss any above items

Photo Permission

Approve

Not Approve

Permission to Campbelltown City Council c/- Campbelltown Arts Centre to use the image and likeness of my child, and/or their art work, as outlined below:

Recordings and images from this program may be edited and used to publicise and promote Campbelltown Arts Centre, or as part of reporting requirements for funding.

Such use includes the display, distribution, publication, transmission, or otherwise use of photographs, images, and/or video taken of participants (including Your Child) and their work, for use in materials that include, but may not be limited to, printed materials such as brochures and newsletters, videos, and digital images such as those on the Campbelltown City Council and Campbelltown Arts Centre website, and social platforms.

This permission applies to learning programs conducted by C-A-C. I acknowledge that if at any stage I no longer wish for My Child’s images to be used, I will notify C-A-C in writing via email to [email protected]