Autumn School Holiday Care Booking Request and Permission Form

The staff at Moe school holiday care program provide a variety of activities within the children’s school holiday program for educational and recreational purposes that occur regularly. We provide opportunities to enhance and foster children’s relationships and participation in peer related activities and experiences, whilst fostering their connection to their world and learning.

Please complete the following form to request a booking for the summer school holidays.

Parent details
Children's details
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Which activity would you like to book?
If there is a possibility of adding days/activities, please select 'permission only granted' for all activities. This will ensure you won't need to complete an additional form. Vacation Care service users will be required to give ONE WEEKS NOTICE to the service administration staff if cancelling a booking.
Tuesday 3 April: Welcome Breakfast and Tenpin Bowling

Wednesday 4 April: Italian Fiesta

Thursday 5 April: Warragul Cinema and Basket and Bonnet Making

Friday 6 April: Mask Making and Mini World Masterpiece

Monday 9 April: Gallery Excursion and Green Thumb Gardening

Tuesday 10 April: Stadium-based Day and Dress-up and Crazy Hair Day

Wednesday 11 April: Stadium-based Day and Fabulous Fruity Fun

Thursday 12 April: Sale Botanic Gardens, Wind Chimes and Dream Catchers

Friday 13 April: Stadium-based Day, Fossick and Find Discovering Crystals and Gems

Your children will travel to all excursions with Latrobe Valley Bus Lines. The children will be supervised with the ratio of one educator to ten children. Risk assessments have been prepared and are available at the service.
I authorise my child/ren to attend the incursions/excursions indicated and agree that the Latrobe City Council and its officers, educators, staff and agents shall be released from, and shall not incur, any responsibility or liability whatsoever for any accident or injury to the child/ren participating in the Vacation Care Program, or for any damage to or loss of property of the child/ren participating in the program.
I authorise Latrobe City Council to obtain medical/ambulance assistance in the case of accident or emergency involving the child/ren and I agree to bear any costs thereby incurred.
I give permission to the staff of Moe Vacation Care, school holiday program to take my child/ren on walking routine outings to Ted Summerton Reserve Moe (oval), Moe South Primary School, Fire Evacuation Practice, Moe Early Learning Centre or/and Apex Park, Waterloo Road.
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Latrobe City Council is committed to the protection of your privacy.
The information on this form will be collated on a database, to assist with planning of vacation care services. The information sought through this form will only be used by Latrobe City Council in conjunction with the Department of Education and Training.