Enrolment form Maitland Regional Art Gallery Enrolment Form Should you have any queries relating to this form please do not hesitate to contact a member of the MRAG team via artgallery@nullmaitland.nsw.gov.au or (02) 4934 9859. The following information is confidential; Maitland City Council will take reasonable care to protect personal information collected from misuse, loss, unauthorised access, modification or disclosure. This information is governed by the Privacy and Personal Information Protection Act 1998 (PPIPA). To ensure that personal information held by MRAG is current, please notify us if any of your details change. Step 1 of 4 25% Student InformationChild 1Child's Name* First Last Date of birth Date Format: MM slash DD slash YYYY AgePlease enter a number from 0 to 100.Membership Number (if applicable)Class/ActivityHome School Art Class (Wednesday)Art Thursday for 6-10 year oldsArt Tuesday for 10-18 year oldsOtherDate/Term Term 4, 2018 Term 1, 2019 Term 2, 2019 Term 3, 2019 Term 4, 2019 Does the participant have any allergies, special needs, or medical conditions:MRAG prides itself on being inclusive and accessible; please do not hesitate to contact a member of the team to discuss individual student requirements. Any information that you can provide will assist us to tailor the program/content to meet student’s needs.Child 2Child's Name First Last Date of birth Date Format: MM slash DD slash YYYY AgePlease enter a number from 0 to 100.Membership Number (if applicable)Class/ActivityHome School Art Class (Wednesday)Art Thursday for 6-10 year oldsArt Tuesday for 10-18 year oldsOtherDate/Term Term 4, 2018 Term 1, 2019 Term 2, 2019 Term 3, 2019 Term 4, 2019 Does the participant have any allergies, special needs, or medical conditions:MRAG prides itself on being inclusive and accessible; please do not hesitate to contact a member of the team to discuss individual student requirements. Any information that you can provide will assist us to tailor the program/content to meet student’s needs.Child 3Child's Name First Last Date of birth Date Format: MM slash DD slash YYYY AgePlease enter a number from 0 to 100.Membership Number (if applicable)Class/ActivityHome School Art Class (Wednesday)Art Thursday for 6-10 year oldsArt Tuesday for 10-18 year oldsOtherDate/Term Term 4, 2018 Term 1, 2019 Term 2, 2019 Term 3, 2019 Term 4, 2019 Does the participant have any allergies, special needs, or medical conditions:MRAG prides itself on being inclusive and accessible; please do not hesitate to contact a member of the team to discuss individual student requirements. Any information that you can provide will assist us to tailor the program/content to meet student’s needs. Parent/Guardian InformationStudents must be collected from Maitland Regional Art Gallery (MRAG) by an authorised parent/guardian/care-giver. Should a situation arise where this is not possible please contact MRAG on 4934 9859. Please note tutors will require proof of identity when you, a guardian or care giver is collecting the child/children for the first time.Contact 1Name of Parent/Guardian* First Last Address Street Address Address Line 2 City State Post Code Email*Please note email is our primary method of communicating important updates; please ensure an email address is provided where possible. Mobile*Home PhoneRelationship to child/children*Contact 2Please provide details of an additional parent/guardian/care-giver or emergency contact:Name of Parent/Guardian/Care-giver* First Last Address Street Address Address Line 2 City State Post Code Email Mobile*Home PhoneRelationship to child/children*Contact 3If required please provide details of a third parent/guardian/care-giver or authorised person.Name of Parent/Guardian/Care-giver First Last Address Street Address Address Line 2 City State Post Code Email MobileHome PhoneRelationship to child/children Lawful AuthorityTo ensure the safety of all children attending classes, Maitland Regional Art Gallery needs to be informed of any relevant Court Orders pertaining to enrolled children. Please read the following notes and complete where necessary:ParentsAll parents have powers and responsibilities in relation to their children, which can only be challenged by a court order. The Children’s Services Regulations 1998 refers to these powers, such as whether or not they have lived together or are married. A court order, such as under the Family Law Act, may take away the authority of a parent to do something or may give it to another person.GuardiansA guardian of a child also has lawful authority. A legal guardian is given lawful authority by a court order. The definition of ‘guardian’ under the Children Services Act 1996 also covers situations where a child does not live with his or her parents and there are no court orders. In these cases the guardian is the person the child loves with who has day to day care and control of the child.Court Orders relating to the child*Are there any orders regarding the powers and responsibilities of the parent in relation to the child/children or access to the child/children? No Yes Current Court Orders relating to the child*Please provide a copy of the original court order/s if these orders: a) Change the powers of a parent/guardian to: authorise the taking of the child outside the service by a staff member of the service, Consent to the medical treatment of the child, Request or permit the administration of medication to the child, Collect the child and / or b) Give these powers to someone else. Please describe these changes and provide the contact detail of any person given powers: Terms & conditions of participation: Children must be dropped off and collected from the workshop space by authorised parents/guardians/care-givers Parents/guardians/care-givers must sign child/children in and out of each class All care will be taken to provide safe work practice instructions to participants Participants must adhere to direction of the MRAG Art Tutor Materials used in workshop spaces are age appropriate for each workshop MRAG cannot guarantee an allergen free environment During children’s classes we encourage students to work independently of parents/guardians/ care-givers. Unless otherwise specified parental involvement in the class is not encouraged. MRAG aspires to be inclusive and accessible and we recognise that the individual needs of students differ and some may require additional support, we encourage you to contact MRAG to discuss individual requirements (02) 4934 9859. Payment terms and conditions Bookings must be made for the full term Please note places are subject to availability and enrolment is not confirmed until full payment is received MRAG cannot refund or credit fees if the child is unable to attend one or more classes Fees are not transferable to another term and are non-refundable once the classes have commenced Should a class need to be cancelled due to insufficient student numbers, the parent or guardian will be notified and either offered a similar course for their child or a refund of the unused portion of the fees paid MRAG reserves the right to alter any arrangements for classes either before or during the term, or to cancel or terminate a class. All efforts will be made to minimise inconvenience to children and their families. Please tick where appropriate: I give consent for Maitland Regional Art Gallery to use images of my child and my child’s artwork for promotional purpose: i.e. workshop brochures, MRAG website, social media and newsletter. I give consent for medical assistance to be provided to the child/children in the case of an accident, injury, trauma, illness or emergency. I would like to receive information on future MRAG workshops and activities via email.
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