First and Surname *
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 PROGRAM...
Registering for a HOLIDAY PROGRAM...
Before and After Holiday Program Care ($7 per session)...
Apr 19
Apr 20
Apr 21
Apr 22
Apr 27
Apr 28
Apr 29
Apr 30
Drop at 8am
Pick-up at 4pm
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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