Workshop Registration

Full name *

Date of Birth *

Gender *

Ethnicity *

If other, please specify

School

If other, please specify school

Parent/Carer Phone *

Parent/Carer Email *

Postcode *

Parent/Carer Name *

Relationship to Child *

Outreach worker *

HAF Code - Required to enroll in program

Child has SEND?

If yes, please provide details

Child has allergies?

If yes, please provide details

Does the child have a medical condition?

If yes, please provide details including medication, dosage, and emergency action

Does the child have dietary requirements?

If yes, please provide details

Leave blank to use parent/carer details.

Emergency Contact Name

Emergency Contact Relationship to Child

Emergency Contact Phone

Emergency Contact Email

* Required fields