Online Form - School Holiday Program - Library & Art Gallery Registration Form

Child Full Name*

Child Age*

Child Gender

Parent or Guardian Contact Name*

Parent or Guardian Contact Number*

Email Address

3D Printing session - 10am-12pm

Tues 4 JulyWed 5 JulyThur 6 JulyFri 7 July

Robotics Session - 1pm - 3pm

Tue 4 JulyWed 5 JulyThu 6 JulyFri 7 July

Medical Information - Are there any medical conditions or medication requirements we should be aware of? (e.g. food allergies, epilepsy, asthma, diabetes etc.)

Photo Consent - I give consent for images to be taken of my child and for these images to be used, modified, and distributed by the Shire of Carnarvon Youth Services.*

YesNo