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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
*
Your email
Which After-School program will your child be attending
*
THURSDAY - starting 20th Oct - Kelso High Campus (3:30 - 5:00pm)
Required
Child's Name (including last name)
*
Your answer
Child's D.O.B. (Date of Birth)
*
MM
/
DD
/
YYYY
Child's address
Your answer
Medical Concerns (type N/A if this does not apply)
*
Your answer
The program cost is $100. Will you be using an Active Kids Voucher as part of your payment?
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Yes, and I have the voucher number now (proceed to next question)
Yes, but I do not currently have the Voucher number
No, (Exergames will be in contact with you via email to organise payment)
Active Kids Voucher code
Your answer
Emergency Contact 1 (Name and Phone Number)
*
Your answer
Emergency Contact 2 (Name and Phone Number)
Your answer
Permission for your child to be in photos/videos for Exergames' publications
*
Yes
No
Permission for your child to walk home after Exergames' Sessions?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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