Exergames After School Program Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

When: Term 4 Tuesdays
Duration: 5 weeks - (Week 2 - Week 6)
Location: Woodward Oval, Parkes
Time: 4-5:30pm

IF YOUR CHILD WAS REGISTERED FOR TERM 3 EXERGAMES THEN YOU ONLY NEED TO COMPLETE THE FIRST 2 QUESTIONS THEN PRESS SUBMIT.

Email *

Child's Name (including last name) *

Was your child registered in Exergames After-School in Term 3? *

Yes (you can ignore remaining questions and press submit if details have stayed the same)

Not sure

Child's D.O.B. (Date of Birth)

YYYY

Child's address

School your child attends

Holy Family Parish School (Parkes)

Parkes Public School (Parkes)

Parkes East Public School (Parkes)

Middleton Public School (Parkes)

Parkes Christian School (Parkes)

Other:

Which program will your child attend? (Select 1)

TUESDAY'S - Woodward oval (4pm - 5:30pm)

Medical Concerns (type N/A if this does not apply)

The program cost is $50. How will you be paying

Cash (hand to an Exergames staff member at the next session)

Online (transfer to Exergames PTY LTD, BSB 802-394, AC 100062942, REF child's name)

Clear selection

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

Yes

Clear selection

Permission for your child to walk home after Exergames' Sessions?

Yes

Clear selection

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms