Kindermusik Registration Form
Our Kindermusik program will help your child’s confidence blossom as he or she learns how to listen, develops physical coordination and tries out new sharing and cooperative skills. But most of all Kindermusik is FUN!

Email address *
Child 1
Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Gender *
Required
Child 2
Name
Your answer
Date of Birth
MM
/
DD
/
YYYY
Age
Your answer
Gender
Primary Carer 1 Name *
Your answer
Mobile Number *
Your answer
Primary Carer 2 Name
Your answer
Mobile Number
Your answer
Home number *
Your answer
Home address *
Your answer
Suburb *
Your answer
Please list allergies, medical conditions, special needs or anything else we need to know about your child
Your answer
Please check the sessions you are interested in attending
Please check which payment option you would prefer
Permission
I give/do not give my permission for Interchange Outer East (IOE) and Kindermusik with Melanie Jane to use photographic and filmed material of:
• myself (volunteer, carer, participant over 18 years)
• my child
• other family members (siblings, etc.)
for the purpose of promotion and information sharing in the following applications:
• IOE newsletters (available on the website)
• IOE publications and marketing material - brochures, booklets, annual reports (available on the website)
• Internet – IOE website/IOE linked sites and applications
• Social media – IOE official Facebook, Twitter, Instagram, YouTube and other social media platforms
• Posters/display boards for festivals, expos and presentations
• Training purposes
• IOE advertisements, articles in newspapers and other community publications (also published on internet)

I am aware that I have the right to withdraw this consent (in writing) at any time and that this consent will remain current unless I withdraw it.

Consent
Do you agree to receive the Interchange Outer East and Kindermusik with Melanie Jane newsletters via email
Please type in name and date IF you have given photo permission consent
Your answer
A copy of your responses will be emailed to the address you provided.
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