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)
Time: 3:30-5pm
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Email *
Child's Name (including last name) *
Child's D.O.B. (Date of Birth) *
MM
/
DD
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YYYY
Child's address *
School your child attends *
Required
Which program will your child attend? (Select 1) *
Required
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? *
Active Kids Voucher Code (which is obtained from https://www.service.nsw.gov.au/transaction/apply-active-kids-voucher)
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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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