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First and Surname *
If you have more children to register, please fill out this form for one child and then email info@yeworkshop.co.nz with the other children's names and Dates of Birth.
Parent(s) Name *
School *
DOB *
MM
/
DD
/
YYYY
Email *
Home Phone *
Cell Phone *
must be different from home number
Emergency Contacts *
Name(s) and Phone Number(s)
Home Address *
Authority to Collect
Name(s) and Phone Number(s)
How did you hear about us? *
Please type the full name of the person who referred you in "other" to get the Promotion Discount. T&Cs apply.
Required
Does your child have any particular health needs that we should be aware of?
Medical conditions, allergies, dietary requirements, learning differences etc.
Registering for a TERM PROGRAMME...
Registering for a HOLIDAY PROGRAMME...
Before and After Holiday Programme Care ($7 per session)...
Not currently availabe
Not currently available
Not currently available.
Not currently available
Not currently available
Not currently available.
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. *
I have read, understand and agree with the Terms and Conditions: https://goo.gl/Zl4QLc *
Required
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