Maker Club Registration 2019
GREYMOUTH
Starting on Wednesday 8th May from 3.30 pm - then every Wednesday, until end of term, 5th July 2019, at Techspace, upstairs at Greymouth Regent Theatre.


HOKITIKA
Starting on Thursday 9th May from 3.30pm - then every Thursday, until end or term, 5th July 2018, at Westland District Library.

For Age: 10-15 years
Parental Permission form to register for Maker Club
MUST BE COMPLETED BY A PARENT OR GUARDIAN
Email address *
Select Venue *
Required
First Name *
Child's Christian Name
Your answer
Surname *
Child's Family Name
Your answer
Age *
Your answer
Year Level at School *
*
Please tick to confirm
Required
Permission for my child to have his/her photo taken for use in related brochures, workbook, website, blogs or on Facebook. *
In order to ensure the safety of your child while in our care please indicate any areas of concern or health issues that Staff at Techspace / Westland District Library should be aware of *
If yes - please provide details in the following section below (all information provided will be kept confidential)
Health issues - Details
If you answered yes above, please provide information on the condition and procedures Techspace / Westland District Library staff need to be aware of.
Your answer
*
Are there any other issues relating to your child’s safety that we need to know about? (eg. custody arrangements, etc) *
If yes - please provide details in the following section below
Other issues - Details
If you answered Yes above - please provide information Techspace / Westland District Library staff need to be aware of
Your answer
Emergency Contact - Name *
In the first instance contact
Your answer
Emergency Contact Phone No. *
Your answer
2nd Emergency Contact- Name *
Your answer
2nd Emergency Contact Phone No. *
Your answer
*
Please tickto confirm
Name of Parent/Guardian completing this form *
Your answer
Parent/Guardian Contact Phone. *
Your answer
Parent/Guardian Contact Email *
Your answer
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