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MakerDojo Registration Form

MakerDojo registration form - 2020

Use this form to register your child/ren with MakerDojo and apply for CCS if desired.

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*

DD
MM
YYYY
Authorised Persons
Use this section to list any person who has authority to pick up your child/ren or be an emergency contact. You can add further authorised persons at any time my email or in person.
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*

DD
MM
YYYY
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.
Cultural background - child 1*
- Neither Aboriginal nor Torres Straight Islander
- Aboriginal
- Torres Straight Islander
- Aboriginal and Torres Straight Islander
What hobbies or interests does this child have? (child 1)*
This helps us to personalise our programs and interactions with your child.
Does you child have any special needs or considerations? (child 1)*
This helps us to ensure your child enjoys our programs fully.
Does your child have any religious or cultural considerations? (child 1)*
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.
Do you wish to register another child?*
- Yes
- No
Details - Child 2
Name - Child 2*
First Preferred name Last
Date of Birth - Child 2*

DD
MM
YYYY
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.
Cultural background - child 2*
- Neither Aboriginal nor Torres Straight Islander
- Aboriginal
- Torres Straight Islander
- Aboriginal and Torres Straight Islander
What hobbies or interests does this child have? (child 2)*
This helps us to personalise our programs and interactions with your child.
Does you child have any special needs or considerations? (child 2)*
This helps us to ensure your child enjoys our programs fully.
Does your child have any religious or cultural considerations? (child 2)*
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.
Do you wish to register another child?*
- Yes
- No
Details - Child 3
Name - Child 3*
First Preferred name Last
Date of Birth - Child 3*

DD
MM
YYYY
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.
Cultural background - child 3*
- Neither Aboriginal nor Torres Straight Islander
- Aboriginal
- Torres Straight Islander
- Aboriginal and Torres Straight Islander
What hobbies or interests does this child have? (child 3)*
This helps us to personalise our programs and interactions with your child.
Does you child have any special needs or considerations? (child 3)*
This helps us to ensure your child enjoys our programs fully.
Does your child have any religious or cultural considerations? (child 3)*
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.
Do you wish to register another child?*
- Yes
- No
Details - Child 4
Name - Child 4*
First Preferred name Last
Date of Birth - Child 4*

DD
MM
YYYY
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.
Cultural background - child 4*
- Neither Aboriginal nor Torres Straight Islander
- Aboriginal
- Torres Straight Islander
- Aboriginal and Torres Straight Islander
What hobbies or interests does this child have? (child 4)*
This helps us to personalise our programs and interactions with your child.
Does you child have any special needs or considerations? (child 4)*
This helps us to ensure your child enjoys our programs fully.
Does your child have any religious or cultural considerations? (child 4)*
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.
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
*
- 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.
*
- 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: https://makerdojo.vic.edu.au/maker-dojo-policies/
How did you hear about us?*

Our Policies

© Innov8 eLearning 2019

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