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Out of Uniform Day School Registration
Name
First
Last
Name of School
Email
Type of School
Please select one of the following that describes your school:
Primary School
Secondary School
Specialist School
Address
Street Address
Address Line 2
City/Suburb
State/Territory
Postcode
Event Date
*
What date is your school participating in Out of School Uniform Day to assist Keeley's Cause fundraising efforts?
Date Format: DD slash MM slash YYYY
How many children attend your school? (Approximately)
Up to 200
200-500
500-1000
1000 or more.
Who will be responsible for the deposit of raised funds to Keeley's Cause bank account?
School Principal
Vice Principal
School Tresurer
Parents and Friends Club President
School Council
Do you require Keeley’s Cause DL Flyers to bring awareness of what children are raising for ?
Yes
No
Please note :
All funds raised must be deposited to Keeley's Cause
Limited within 7 days of your fundraising event.
Funds are to be deposited to
Keeleys Cause Limited
Bendigo Bank
BSB : 633-000
ACC
Or
By Cheque payable to KEELEYS CAUSE and sent via express
post to
KEELEYS CAUSE
P.O. BOX 169
BALLAN VIC 3342
Please select your preferred payment:
*
Direct Deposit to Keeley's Cause Bank Account
Cheque Payable to Keeley's Cause Forwarded by Express Post
Third Choice
Do you currently have any children with Autism or an Intellectual Disability at your school?
*
Yes
No
If yes, then how many children attend your school with Autism or an Intellectual Disability?
1
2-3
4-6
6-10
10 or more
How many of them have an iPad at your school?
0
1
2-3
4-6
6-10
10 and over
Thank you for your time in filling out this form.