Thrive Booking Form

Program Details
Term: Term 2 only
Duration: 10 week program (Primary) / 9 week program (High School Girls)
Start Date: 28 April 2026

Location: Kesser Torah College

Schedule:
Girls (Primary): Tuesdays
Girls (High School): Tuesdays (4:05pm – 5:00pm)
Boys: Wednesdays

Time:
Primary: 3:20pm – 5:00pm
High School Girls: 4:05pm – 5:00pm

Ages:
Primary: Years 1–6 (divided into age appropriate groups)
High School Girls: Years 7+

Cost
Thanks to support from a Multicultural NSW grant, this program is heavily subsidised.

Primary Program:
Full value: $450
Parent contribution: $90 for the full 10 week term
Less than $10 per session

High School Girls Program:
Parent contribution: $75 for the full 9 week term

Contact: [email protected]

Child 1 Full Name*

First Name Last Name

Child 1 Birth Date*

Month Day Year

Child 1 Gender*

Child 1 School Name*

Child 1 School Year *

Child 2 Full Name

First Name Last Name

Child 2 Birth Date

Month Day Year

Child 2 Gender

Child 2 School Name

Child 2 School Year

Child 3 Full Name

First Name Last Name

Child 3 Birth Date

Month Day Year

Child 3 Gender

Child 3 School Name

Child 3 School Year

Parent / Gaurdian Name*

First Name Last Name

E-mail*

I would like to receive news and updates by email

Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Emergency contact*

First Name Last Name

Relationship to child*

Phone Number*

Area Code Phone Number

Medical information:*

Expiry Date*

Private hospital insurance fund and number

Full list of all current medications and dosages *

Drug allergies

Any medical conditions (past and current) *

Date of latest booster (including ADT, triple antigen, infanrix or CDT vaccines)

Local GP: name, address, office phone and after hours phone/mobile*

Snacks and drinks will be supplied to keep our campers energized and hydrated.

Payment Information

Thanks to support from a Multicultural NSW grant, this program is heavily subsidised.

Full value: $450

Primary School Parent contribution: $90 for the full 10 week term

High School Parent contribution: $75 for the full 19 week term

Cancellation Policy

Due to limited places and the heavily subsidised nature of the program, the following policy applies:

Cancellations made before the program begins (by 27 April) will receive a full refund

Cancellations made after the program has started are not refundable

In exceptional circumstances, a partial credit may be considered at our discretion

Payment* Amount depending on number of children registered in this form

Total

$0.00 AUD

Payment*

Credit Card

We accept Visa, MasterCard, American Express
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

By enrolling my child in the thrive program, I agree to and accept all Chabad Youth NSW policies on their behalf, including the behaviour policy, available at cyn.org.au/cgipolicies.*

I agree

I consent to photographs and media being taken during the program, which may include my child(ren), for promotional purposes. I understand I can opt out by notifying the organisers in writing prior to the program.*

I agreeI dont agree

For a full list of our Policies and Procedures, please click here

I acknowledge and accept that Lubavitch Jewish Centre (trading as Chabad Youth NSW) and Kesser Torah College, including their employees and agents, will take all reasonable care in the supervision of my child. I understand that participation in program activities involves a degree of inherent risk, and I agree that the above organisations are not liable for any injury or harm that may occur, except where required by law.

In the event that my child becomes ill or injured during the program, I authorise the above organisations to take all reasonable steps to ensure my child receives appropriate medical attention. I accept responsibility for any medical expenses incurred.

I understand that all program activities will take place on site at Kesser Torah College, and I give permission for my child to participate in all program activities conducted as part of THRIVE.

I agree to indemnify Lubavitch Jewish Centre (trading as Chabad Youth NSW), Kesser Torah College, and their employees and agents against any claims, demands, or actions arising from my child’s behaviour or actions during the program.

Parent / Guardian*

First Name Last Name

Date*

Month Day Year

at Hour Minutes

For more information please email [email protected] or call 0433 549 190

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