Exergames After School Program Registration
When: Term 4, 2022
Duration: 8 weeks, Weeks 2-9 Term 4
Location: Kelso High Campus, Kelso
Time: 3:30pm - 5:00pm

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Email *
Which After-School program will your child be attending *
Required
Child's Name (including last name) *
Child's D.O.B. (Date of Birth) *
MM
/
DD
/
YYYY
Child's address
Medical Concerns (type N/A if this does not apply) *
The program cost is $100. Will you be using an Active Kids Voucher as part of your payment? *
Active Kids Voucher code
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Emergency Contact 1 (Name and Phone Number) *
Emergency Contact 2 (Name and Phone Number)
Permission for your child to be in photos/videos for Exergames' publications *
Permission for your child to walk home after Exergames' Sessions? *
A copy of your responses will be emailed to the address you provided.
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