Wangaratta Coding Club Registration Form
Term 3 2020
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Email *
Child's Name *
Child's Date of Birth *
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Child's current age and grade at school *
Child's School *
Parent/Guardian Name *
Street Address *
Town *
Postcode *
Email *
Phone number *
Emergency Contact Name *
Emergency Contact Phone *
Emergency Contact relationship to child *
Does your child have any medical conditions that may require an emergency response *
If yes above, please provide some details
If yes, I accept that I am responsible for providing a copy of a current emergency management plan relevant to my child's specified health condition
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I consent to the adults responsible for supervising the activities my child will participate in at the Wangaratta Digital Hub, seeking any emergency medical assistance (including ambulance) deemed necessary for my child whilst at the Wangaratta Digital Hub *
Has your child done any coding before? *
If yes above, where did they learn some coding and what programs did they learn?
Which level of coding are you wanting to enrol your child in to? (please refer to website for information about the two levels on offer) *
Please tell us how you heard about the Wangaratta Coding Club? *
Required
Do you consent to your child being included in photos and videos at the Coding Club and to these images being used for promotional purposes which may include media publications, social media, websites, educational displays and hub presentations etc. *
I understand that my child needs to be signed in and out of each Coding session by the adult responsible for dropping off or picking up my child *
If I am unable to personally pick up my child at the end of a Coding Session, I consent to: *
Required
Under the above arrangement I understand and accept that Wangaratta Digital Hub has no responsibility for my child once my child is signed out at the end of a session and I assume full responsibility for all risks associated with my child traveling home independently or with a nominated person.
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Name, phone number and relationship to child of person/s nominated as authorised by me to pick up my child from the Wangaratta Digital Hub if I am unavailable to do so. **Please note that your child will not be released to anyone not listed below
The Wangaratta Coding Club was initially established by a group of parents with the support of the Wangaratta Digital Hub. We ask that parents/guardians volunteer to assist for at least one or more sessions during the term ( no experience required) Please indicate which session/s you can volunteer to assist with? *
Required
Does your child have access to: *
Required
The coding programs have higher functionality on a laptop. Can your child bring a laptop to the sessions each week?
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Please provide any other information (if applicable) about your child that you would like us to know to assist in meeting your child's individual learning needs?
Safety and Liability Statement *
Required
By submitting this form I declare that I have read, understood and accept the Coding Club Participation Agreement downloadable on the Wangaratta Digital Hub website. *
By submitting this form I declare that I understand that the Wangaratta Digital Hub staff and volunteers will rely on the information provided on this registration form and I confirm that the information is true and correct. *
Date that I read and understood the above statements *
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Thanks for completing this form. Next step is to pay your program fee. Please follow the links on the website.
A copy of your responses will be emailed to the address you provided.
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