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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 *

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? *

Friend/Family

Google Search

Event Finda

Social Media

Newspaper

Flyer

Other:

Required

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

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

Monday After-school programme Sunnyhills school years 4-6

Tuesday After-school programme Sunnyhils school years 2-4

Wednesday After-school programme Sunnyhills school years 2-4

Wednesday After-school programme Shelly Park Primary years 4-6

Other:

POWER UP ENGINEERS Monday Sept 29

PLAYBOTICS Tuesday Sept 30th

MECH-SAFARI: BEAST BUILDERS Wednesday Oct 1st

Before and After Holiday Programme Care ($7.50 per session)...

8am drop off

4pm pick up

Monday Sept 29th

Tuesday Sept 30th

Wednesday Oct 1st

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 *

Yes, I agree

Required

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