MakerDojo Registration Form

Details - Parent/Guardian 1

Name - Parent/Guardian 1*

First Last

Address - Parent/Guardian 1*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email - Parent/Guardian 1*

Enter Email Confirm Email

Phone Number - Parent/Guardian 1*

Do you wish to claim CCS?*

Yes
No

CRN - Parent/Guardian 1 (this must be a 9 digit number and single capital letter)*

Date of Birth - Parent/Guardian 1*

Relationship to child/ren*

Authorised Persons

Use this section to list any additional person who has authority to pick up your child/ren or be an emergency contact. You can add further authorised persons at any time by email. We cannot release a child to a person who is not listed as an authorized person or nominee on the child’s enrolment record.

Do you wish to add another authorised person?

Yes
No

Name (authorised person 1)*

First Last

Relationship to child/ren (authorised person 1)*

Phone number (authorised person 1)*

Authority (authorised person 1)*

Pick up child/ren
Emergency contact

Tick all that apply.

Do you wish to add another authorised person?

Yes
No

Name (authorised person 2)*

First Last

Relationship to child/ren (authorised person 2)*

Phone number (authorised person 2)*

Authority (authorised person 2)*

Pick up child/ren
Emergency contact

Tick all that apply.

Do you wish to add another authorised person?

Yes
No

Name (authorised person 3)*

First Last

Relationship to child/ren (authorised person 3)*

Phone number (authorised person 3)*

Authority (authorised person 3)*

Pick up child/ren
Emergency contact

Tick all that apply.

Details - Child 1

Name - Child 1*

First Preferred name Last

Date of Birth - Child 1*

CRN - Child 1 (this must be a 9 digit number and single capital letter)*

Child's current school*

Child's current grade/year level*

Address - child 1

Same as Parent/Guardian 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender - Child 1*

Male
Female
Prefer not to say/unspecified

Are there any court orders relating to this child that impact on this registration or attendance at MakerDojo? (child 1)*

Yes (please provide a copy to MakerDojo)
No

Please include any orders that outline restricted or prohibited access to this child.

Does your child have any additional needs or considerations? (child 1)*

Yes
No

Please elaborate on your child's additional needs or considerations? (child 1)*

This helps us to ensure your child enjoys our programs fully. The more you can share, the better the experience for your child and the more support we can provide.

IMPORTANT: Have you filled out and returned the Inclusion Support Program consent forms? (child 1)*

Yes
No

Copy - Paste the following link into your browser: https://makerdojo.vic.edu.au/makerdojos-inclusion-support-programme-isp/

Visit MakerDojo's Inclusion Support Program to download the forms. Don't forget to email the forms back to sensei@makerdojo.vic.edu.au as quickly as possible. We need to allow time for government approval so the earlier you can return the forms, the better.

Does your child have any religious or cultural considerations? (child 1)*

Yes
No

Cultural background - (child 1)*

Aboriginal
Torres Straight Islander
Aboriginal and Torres Straight Islander
From a culturally or linguistically diverse background
From a refugee or humanitarian background

Does your child identify as

Does you child have asthma or any allergies or sensitivities? (child 1)*

None
Asthma
Allergy
Sensitivity

Select all that apply.

Asthma details - (child 1)*

Please provide the Asthma action plan to MakerDojo prior to attendance. Any medication, including puffers or inhalers should be brought with the child each day.

Allergy details - (child 1)*

Please outline any allergies your child has and the medical action plan should your child come into contact with this allergen. If your child is at risk of anaphylaxis, a signed Anaphylaxis action plan must be provided to MakerDojo before attendance. An in-date Epipen must be brought with the child each day, along with any antihistamine specified in the Action Plan.

Sensitivity details - (child 1)*

Please outline any sensitivities your child has and the medical action plan should your child come into contact with this allergen.

What hobbies or interests does this child have? (child 1)*

This helps us to personalise our programs and interactions with your child.

Do you wish to register another child?*

Yes
No

Details - Child 2

Name - Child 2*

First Preferred name Last

Date of Birth - Child 2*

CRN - Child 2 (this must be a 9 digit number and single capital letter)*

Child's current school*

Child's current grade/year level*

Address - child 2*

Same as Parent/Guardian 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender - Child 2*

Male
Female
Prefer not to say/unspecified

Are there any court orders relating to this child that impact on this registration or attendance at MakerDojo? (child 2)*

Yes (please provide a copy to MakerDojo)
No

Please include any orders that outline restricted or prohibited access to this child.

Does your child have any additional needs or considerations? (child 2)*

Yes
No

Please elaborate on your child's additional needs or considerations? (child 2)*

This helps us to ensure your child enjoys our programs fully. The more you can share, the better the experience for your child and the more support we can provide.

IMPORTANT: Have you filled out and returned the Inclusion Support Program consent forms? (child 2)*

Yes
No

https://makerdojo.vic.edu.au/makerdojos-inclusion-support-programme-isp/

Visit MakerDojo's Inclusion Support Program to download the forms. Don't forget to email the forms back to sensei@makerdojo.vic.edu.au as quickly as possible. We need to allow time for government approval so the earlier you can return the forms, the better.

Does your child have any religious or cultural considerations? (child 2)*

Yes
No

Cultural background - (child 2)*

Aboriginal
Torres Straight Islander
Aboriginal and Torres Straight Islander
From a culturally or linguistically diverse background
From a refugee or humanitarian background

Does your child identify as

Does you child have asthma or any allergies or sensitivities? (child 2)*

None
Asthma
Allergy
Sensitivity

Select all that apply.

Asthma details - (child 2)*

Please provide the Asthma action plan to MakerDojo prior to attendance. Any medication, including puffers or inhalers should be brought with the child each day.

Allergy details - (child 2)*

Please outline any allergies your child has and the medical action plan should your child come into contact with this allergen. If your child is at risk of anaphylaxis, a signed Anaphylaxis action plan must be provided to MakerDojo before attendance. An in-date Epipen must be brought with the child each day, along with any antihistamine specified in the Action Plan.

Sensitivity details - (child 2)*

Please outline any sensitivities your child has and the medical action plan should your child come into contact with this allergen.

What hobbies or interests does this child have? (child 2)*

This helps us to personalise our programs and interactions with your child.

Do you wish to register another child?*

Yes
No

Details - Child 3

Name - Child 3*

First Preferred name Last

Date of Birth - Child 3*

CRN - Child 3 (this must be a 9 digit number and single capital letter)*

Child's current school*

Child's current grade/year level*

Address - child 3*

Same as Parent/Guardian 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender - Child 3*

Male
Female
Prefer not to say/unspecified

Are there any court orders relating to this child that impact on this registration or attendance at MakerDojo? (child 3)*

Yes (please provide a copy to MakerDojo)
No

Please include any orders that outline restricted or prohibited access to this child.

Does your child have any additional needs or considerations? (child 3)*

Yes
No

Please elaborate on your child's additional needs or considerations? (child 3)*

This helps us to ensure your child enjoys our programs fully. The more you can share, the better the experience for your child and the more support we can provide.

IMPORTANT: Have you filled out and returned the Inclusion Support Programme consent forms? (child 3)*

Yes
No

Copy - Paste the following link into your browser: https://makerdojo.vic.edu.au/makerdojos-inclusion-support-programme-isp/

Visit MakerDojo's Inclusion Support Program to download the forms. Don't forget to email the forms back to sensei@makerdojo.vic.edu.au as quickly as possible. We need to allow time for government approval so the earlier you can return the forms, the better.

Does your child have any religious or cultural considerations? (child 3)*

Yes
No

Cultural background - (child 3)*

Aboriginal
Torres Straight Islander
Aboriginal and Torres Straight Islander
From a culturally or linguistically diverse background
From a refugee or humanitarian background

Does your child identify as

Does you child have asthma or any allergies or sensitivities? (child 3)*

None
Asthma
Allergy
Sensitivity

Select all that apply.

Asthma details - (child 3)*

Please provide the Asthma action plan to MakerDojo prior to attendance. Any medication, including puffers or inhalers should be brought with the child each day.

Allergy details - (child 3)*

Please outline any allergies your child has and the medical action plan should your child come into contact with this allergen. If your child is at risk of anaphylaxis, a signed Anaphylaxis action plan must be provided to MakerDojo before attendance. An in-date Epipen must be brought with the child each day, along with any antihistamine specified in the Action Plan.

Sensitivity details - (child 3)*

Please outline any sensitivities your child has and the medical action plan should your child come into contact with this allergen.

What hobbies or interests does this child have? (child 3)*

This helps us to personalise our programs and interactions with your child.

Do you wish to register another child?*

Yes
No

Details - Child 4

Name - Child 4*

First Preferred name Last

Date of Birth - Child 4*

CRN - Child 4 (this must be a 9 digit number and single capital letter)*

Child's current school*

Child's current grade/year level*

Address - child 4*

Same as Parent/Guardian 1

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender - child 4*

Male
Female
Prefer not to say/unspecified

Are there any court orders relating to this child that impact on this registration or attendance at MakerDojo? (child 4)*

Yes (please provide a copy to MakerDojo)
No

Please include any orders that outline restricted or prohibited access to this child.

Does your child have any additional needs or considerations? (child 4)*

Yes
No

Please elaborate on your child's additional needs or considerations? (child 4)*

This helps us to ensure your child enjoys our programs fully. The more you can share, the better the experience for your child and the more support we can provide.

IMPORTANT: Have you filled out and returned the Inclusion Support Programme consent forms? (child 4)*

Yes
No

Copy - Paste the following link into your browser: https://makerdojo.vic.edu.au/makerdojos-inclusion-support-programme-isp/

Visit MakerDojo's Inclusion Support Program to download the forms. Don't forget to email the forms back to sensei@makerdojo.vic.edu.au as quickly as possible. We need to allow time for government approval so the earlier you can return the forms, the better.

Does your child have any religious or cultural considerations? (child 4)*

Yes
No

Cultural background - (child 4)*

Aboriginal
Torres Straight Islander
Aboriginal and Torres Straight Islander
From a culturally or linguistically diverse background
From a refugee or humanitarian background

Does your child identify as

Does you child have asthma or any allergies or sensitivities? (child 4)*

None
Asthma
Allergy
Sensitivity

Select all that apply.

Asthma details - (child 4)*

Please provide the Asthma action plan to MakerDojo prior to attendance. Any medication, including puffers or inhalers should be brought with the child each day.

Allergy details - (child 4)*

Please outline any allergies your child has and the medical action plan should your child come into contact with this allergen. If your child is at risk of anaphylaxis, a signed Anaphylaxis action plan must be provided to MakerDojo before attendance. An in-date Epipen must be brought with the child each day, along with any antihistamine specified in the Action Plan.

Sensitivity details - (child 4)*

Please outline any sensitivities your child has and the medical action plan should your child come into contact with this allergen.

What hobbies or interests does this child have? (child 4)*

This helps us to personalise our programs and interactions with your child.

Consents and Agreements

I declare that all information and documents provided as part of this registration are true and correct and that any changes will be communicated to MakerDojo in writing.

I consent for MakerDojo to seek medical treatment for my child/ren from a first aid officer, medical practitioner, hospital or ambulance in the event I cannot be contacted.

I consent to images and videos of my child/ren to be taken during MakerDojo activities

Sunsafe hate and sunscreen consent*

I consent to supply my child/ren with a sunsafe hat and for sunscreen to be applied to my child/ren before outdoor activities. If my child/ren has a sensitivity to sunscreen, I agree to supply appropriate sunscreen.

I agree to keep my child/ren away from MakerDojo if they display any symptoms that would be considered contagious and to collect or make arrangements for my child/ren to be collected if they become unwell during a program.

Policies and procedures agreement*

I have read and understood MakerDojo's policies and procedures and agree to follow these as a condition of registration.

MakerDojo's policies and procedures can be viewed here (copy-paste into browser or click the link in the footer) : https://makerdojo.vic.edu.au/maker-dojo-policies/

How did you hear about us?*

Please elaborate

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Name

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MakerDojo Registration Form

MakerDojo registration/enrolment form

Details - Parent/Guardian 1

Authorised Persons

Details - Child 1

Details - Child 2

Details - Child 3

Details - Child 4

Consents and Agreements