Bubblegum Jukebox Enrolment Jan 20th - Jan 24th Child's Name * First Name Last Name Child's Age * Child's Gender * Female Male Non-Binary Other What school does your child attend? * Parents Name * First Name Last Name Parent's Email * Parent's Phone * (###) ### #### 2nd Contact Name * First Name Last Name 2nd Contact's Email * 2nd Contact's Phone * (###) ### #### Does your child have any allergies or medical conditions? * Physical & Mental (please include mental health) Does your child carry any medications? * How many days is your child attending for? * Our minimum is 3 days - please read FAQ's if you have any questions 3 Days $255 ($85/Day) Wed - Fri 4 Days $310 ($77.50/Day) Tues - Fri 5 Days $365 ($73/Day) Mon - Fri I give permission for Bubblegum Jukebox to use any photos of my child/children as promotional material. * Yes No I give permission for Bubblegum Jukebox staff to administer first aid treatment if necessary. * Yes I give permission for my child to be guided across the road to the local play park. * Every lunch we walk to Attunga Park, more information will be provided in your child's enrolment confirmation. Yes No How did you find out about Bubblegum Jukebox? Please mention the name of someone who referred you or where you found out about us. Thank you!
