Children Activities, Townsville

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Scribbles & Squiggles

Child's Details

First Name

Surname

Date of Birth (dd/mm/yy)

Does your child have any health concerns we should know about?

Parent / Guardian's Details

First Name

Surname

Home Phone

Work Phone

Mobile

Email

Postal Address

Session Time Enrolling In

Please tick to indicate the session time you are enrolling in. We will contact you asap if that session is booked out. Our places fill as term bookings. 1pm Thursday - Little Picassos [12 - 18months] 2pm Thursday - Creative Explorers [2 - 4years] 3pm Thursday - Creative Explorers [2 - 4years] 4pm Thursday - Creative Kids [5 - 10years]

Payment Details

Fees are $165 for a 10 week term and are due in full on the first day of term. A deposit of $50 is due to secure your place. Places are not held without a deposit or payment. Please tick your preferred payment method: Direct Deposit Account Name Kylie E Bartlett BSB: 064823 Account Number: 10 651 567 Reference: Please use your child's name Cheque Payable to Kylie Bartlett Leave at reception of the Harmony Centre Or Post to PO Box 1570 Aitkenvale 4814 Once we have your enrollment form and payment we will send you an email confirmation of your enrollment.

Enrolment Conditions
Your booking will lapse if we do not receive full payment by the first day of term Payment is required prior to your child participating in our program. Once the program commences no refunds are given Your child's enrolment will be confirmed upon payment and receipt of this form signed by you By proceeding with your child's enrolment you agree to these conditions and the terms of enrolment as listed over the page.
How did you find us?

Word of Mouth - Their name please Brochure Phone Book Yellow Pages Website Magazine Ad/Article Newspaper If someone has referred you to our program please let us know so we can personally thank them.

Terms and Conditions of Enrolment

A. Child Supervision I, as the parent/guardian, acknowledge that I am required to supervise my child and have responsibility for the care of my child during Scribbles and Squiggles art workshops at the Harmony Centre. B. Promotional Photo Permission I as the parent/guardian give permission do not give permission on occasion for my child and my child's artwork to be photographed during the Scribbles and Squiggles Art Workshops or Holiday Program and for these photos to be released and utilised in broadcast media, electronic media including Scribbles and Squiggles term newsletter, website, print media, and related educational or marketing activities at any time in the future for the promotion and marketing of Scribbles and Squiggles. C. Cancellations We reserve the right to alter or re-arrange individual sessions or an entire program in the event of venue problems, insufficient enrollment or other factors which are unforeseen or beyond our control. If you know you will be absent for a period longer than two weeks during the term please let us know at the time of enrolment prior to commencement of the term and a payment reduction of in term fees will be applied. This is not applicable to unforeseen absences during the term. I agree to terms A. B. and C. as above

Future Contact

Please indicate the best form of contact for you: Email Sms Phone Post Privacy Your privacy is protected and your details will only be utilised by Scribbles and Squiggles to inform you about our program and anything to do with our program. Your details will never be shared with a third party without your written authorisation.


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