Exergames After School Program Registration
When: Term 4 Tuesdays
Duration: 5 weeks - (Week 2 - Week 6)
Location: Woodward Oval, Parkes
Time: 4-5:30pm

IF YOUR CHILD WAS REGISTERED FOR TERM 3 EXERGAMES THEN YOU ONLY NEED TO COMPLETE THE FIRST 2 QUESTIONS THEN PRESS SUBMIT.
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Email *
Child's Name (including last name) *
Was your child registered in Exergames After-School in Term 3? *
Child's D.O.B. (Date of Birth)
MM
/
DD
/
YYYY
Child's address
School your child attends
Which program will your child attend? (Select 1)
Medical Concerns (type N/A if this does not apply)
The program cost is $50. How will you be paying
Clear selection
Emergency Contact 1 (Name and Phone Number)
Emergency Contact 2 (Name and Phone Number)
Permission for your child to be in photos/videos for Exergames' publications
Clear selection
Permission for your child to walk home after Exergames' Sessions?
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
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