Child's Name *

First Name

Last Name

Parents Name *

First Name

Last Name

Parent's Phone *

(###)

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2nd Contact Name *

First Name

Last Name

2nd Contact's Phone *

(###)

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How many days is your child attending for? *

4 DAYS ONLY DUE TO GOOD FRIDAY. Our minimum is 3 days - please read FAQ's if you have any questions

3 Days $255 ($85/Day) Tues - Thurs

4 Days $310 ($77.50/Day) Mon - Thurs

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

If your child is seriously hurt, an ambulance will be called by staff. Any fees that are incurred from the ambulance call out and transport must be paid by you. Bubblegum Jukebox is not responsible for any fees incurred by hospital visits. *

I agree

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