3D IoT Holiday Program
Please fill up this form to enrol your child.

Venue: Level 1, 15-33 Alfred Street, Blackburn.
Contact: David Ng, 0403 277 934, david.ng@cnaptic.com.au
Cost: $70/day. Please pay on the day by cash or credit card.

Remember to bring lunch or snack.

Email address
Child's Name
You may enter more than one name (separate with comma) if you enrol more than one child. Please indicate any special needs for specific child below.
Your answer
Parent/Guardian Name
Your answer
Contact Number
Your answer
Photo Permission
I give permission for Cnaptic staff to take photographs of my child for use on www.cnaptic.com.au, social media sites, and displayed within the premise. I am aware that photos of my child may be included in group photos.
Day(s) my child would like to join
Our activities typically can be completed in one day. Extensions and challenges are available if your child joins multiple days. Our program starts at 9am and finishes at 3pm.
Required
Special Needs
Please let us know if your child has special dietary requirement or require any medical attention.
Your answer
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This form was created inside of Cnaptic. Report Abuse - Terms of Service - Additional Terms