Young Engineers Workshop Enrolment Form

First and Surname

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Parent(s) Name

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School

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DOB

Email

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Home Phone

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Cell Phone

must be different from home number

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Emergency Contacts

Name(s) and Phone Number(s)

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Home Address

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Authority to Collect

Name(s) and Phone Number(s)

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Does your child have any particular health needs that we should be aware of?

Medical conditions, allergies, dietary requirements, learning differences etc.

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Register for a HOLIDAY PROGRAM...

RoboExplorers, Ages 5-7 Mon-Tue Sept 30-Oct 1 9-3 Anchorage Park Community House Pakuranga
Robothon, Ages 8+ Mon-Tue Sept 30-Oct 1 9-3 Anchorage Park Community House Pakuranga
RoboSports, Ages 5-7 October 4th 9-3 Howick Library
RoboSports, Ages 8+ October 4th 9-3 Howick Library
Theme Park Engineers, Ages 5-7 October 11th 9-3 Howick Library
Theme Park Engineers, Ages 8+ October 11th 9-3 Howick Library

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Do you need before/after care for a HOLIDAY PROGRAM?

	Drop-off at 8am $7	Pick-up at 4pm $7
Mon, September 30th
Tues, October 1st
Friday, October 4th
Friday, October 11th

Please enter one response per row

Registering for a TERM PROGRAM...

Monday After-School Sunnyhills School Years 4-6
Tuesday After-school Sunnyhils School Years 2-3
Wednesday Ages 5-7 Shelly Park Primary
Wednesday After-school Ages 8+ Shelly Park Primary
Thursday After-school Ages 10+ Botany
Friday After-school Ages 7-9 Botany
Friday After-school Ages 5-7 Shelly Park Primary
Other:

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I grant Young Engineers Workshop program operators permission to use photographs and film of my child or my child’s work, alone or included with others, for educational and promotional purposes in any media format.

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I have read, understand and agree with the Terms and Conditions: https://goo.gl/Zl4QLc

Yes, I agree

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