Exergames After School Program Registration
When: Term 4 - Thursdays
Duration: 9 weeks (including 1 week free trial) - (Week 2 - Week 10)
Location: Lindner Oval (Peak Hill)
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Child's Name (including last name)
Child's D.O.B. (Date of Birth)
School your child attends
Peak Hill Central School (Peak Hill)
St Joseph's Parish School (Peak Hill)
Which program will your child attend? (Select 1)
THURSDAY'S - Peak Hill - Lindner Oval (3:30pm - 5pm)
Medical Concerns (type N/A if this does not apply)
The program cost is $99. Will you be using an Active Kids Voucher as payment?
Yes, and I have the voucher number now (proceed to next question)
Yes, but I do not currently have the Voucher number
No, (Exergames will be in contact with you to organise payment near the starting date)
Active Kids Voucher Code (which is obtained from
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
Permission for your child to walk home after Exergames' Sessions?
A copy of your responses will be emailed to the address you provided.
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