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EDUCATION QUEENSLAND INTERNATIONAL HOLIDAY PROGRAM STUDENT ...
EDUCATION QUEENSLAND INTERNATIONAL HOLIDAY PROGRAM STUDENT REGISTRATION FORM TOUR DETAILS Northern Territory Safari East Coast Safari $2550 (including flights from Brisbane) $2650 (including flights from Brisbane) 18 September to 3 October 2010 18 to 30 September 2010 Cairns Safari Sydney Safari $1910 (including flights from Brisbane) $1550 (including flights from Brisbane) 19 to 24 September 2010 26 September to 1 October 2010 (Registrations close – 8 August 2010) STUDENT’S DETAILS First Name: Family Name: Date of Birth: Nationality: School name: Home phone: Mobile phone: Homestay Address: Student email: HOST FAMILY CONTACT DETAILS Full name/s: Home phone: Mobile phone: Work phone: Email: PAYMENT OPTIONS OPTION 1: I have made a Telegraphic Transfer on (date) for $ For ALL Overseas Telegraphic Transfers you MUST quote the Safari ID number AND provide a copy of the transfer. Transfers will NOT be allocated without proof of payment. Northern Territory Safari ID – SF185 East Coast Safari ID – SF186 Cairns Safari ID – SF182 Sydney Safari ID – SF184 BANK DETAILS Westpac Bank, 83/85 The Boulevard, Toronto NSW 2283 A/c Name: Terra Australis Camp Services BSB: 032 514 A/c No: 144710 Swift Code: WPACAU2S IBAN: 032514144710 OPTION 2: I authorise Terra Australis to debit my credit card. I understand any outstanding balance will be deducted on the date due. Please charge: Visa MasterCard Card Number: Expiry date: _____/_____ Amount: $__________Deposit or full amount (please circle) Card holder’s name (please print): *** Credit card payments attract a 2% surcharge FLIGHT INFORMATION Do you require flights from a regional location (e.g. Cairns, Townsville, Rockhampton etc)? If Yes, please advise your preferred departure location: MEDICAL/MEDICATION INFORMATION Do you have any medical problems (such as allergies, asthma, epilepsy etc)? Yes No If Yes, please give details: Do you require any Medical treatment on a regular basis? Yes No If Yes, please give details: DIETARY REQUIREMENTS Do you have any dietary requirements (for example vegetarian, halal, gluten free)? Yes No If Yes, please give details: PARENT AND STUDENT AUTHORISATION This document relates to your son/daughter’s participation in a school holiday excursion that is being coordinated by Education Queensland International (EQI). EQI requires the parents of every student participating in these holiday programs to read this document carefully and sign it and return it to your child’s host school as soon as possible. Holiday Program Conditions and Code of Behaviour • Programs are fully supervised by Education Queensland staff. • Parent and Student Authorisation Form and Travel Request Form must be completed, signed and returned before 3 September 2010. • Payment must be finalised within 10 working days of the tour company receiving a completed registration form. • The prices advertised on page 1 of this form include return flights from Brisbane. The prices are guaranteed to the first 28 applicants ONLY. Subsequent applications will be charged the non-flight price of $1465pp for Cairns, $1300pp for Sydney, $2170pp for East Coast and $2120 for Northern Territory and the flight rate of the day. The flight rate of the day can fluctuate from $250 - $1000. • The Cancellation policy is as follows: 60 days and over $150 59 to 35 days $500 34 to 1 days 80% of the full fare • All pre-departure information will be sent to students at their nominated homestay address at least 2 weeks prior to the departure date. • Students may not leave the accommodation area without permission from the Education Queensland teacher/escort. • Smoking, drinking of alcohol or the taking of non-prescribed drugs is strictly forbidden at all times. • Students are expected to comply with instructions given by the Education Queensland teacher/escort. • In accommodation boys and girls are to stay in their respective sleeping areas. • Students are responsible for their own luggage and personal belongings. • Large sums of cash/valuable items (except cameras) are not to be carried by students. • Where students are permitted independent activity, they are to reassemble at the designated time and place without fail. • Students must carry a copy of the program itinerary at all times and ensure they have a copy of the current accommodation address and phone numbers. • If a student/s become/s lost they should telephone the teacher/escort by mobile phone, if this is unsuccessful, they should proceed by taxi to the accommodation as detailed in the itinerary and notify hotel staff of their return. • In public places students are to behave in an orderly manner and follow all instructions given by the Education Queensland teacher/escort. A breach of this Code of Behaviour may result in the student’s participation in the holiday program being cancelled and the student being returned to their homestay on the first available transport. Parents and the student’s host family and host school will be notified and any additional expenses incurred will by the responsibility of the student/parents/guardian. MEDICAL I authorise the Education Queensland representative to obtain, on my behalf, such medical assistance that my son/daughter may require in the event of accident or illness and guarantee to meet any costs incurred. I authorise the administering of anaesthetic if the medical officer attending my son/daughter deems this necessary. I have read, understand and agree to abide by the conditions above. Student’s Name: Parent’s Name: Student’s Signature: Parent’s Signature: Date: Date: Once completed, please print and sign this form and return via email to EQIHolidayPrograms@deta.qld.gov.au by 8 August 2010. If you have any questions regarding this form or program, please email EQIHolidayPrograms@deta.qld.gov.au. THANK YOU
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