REGISTRATION FORM
Registration for Digital Technologies After School Programme
Child(ren)
Number of children enrolling *
Child(ren)’s Full Name(s) *
Age(s)
School ; Year at school *
Parents/Guardians
Name (#1) *
Relationship to child
Clear selection
Address *
Email *
Phone Work/Mobile *
Name (#2) *
Relationship to child
Clear selection
Email *
Phone Work/Mobile *
Emergency Contact
Please provide contacts of someone we can contact if we are unable to reach parents/guardian
Full Name
Address
Phone
Times & Venues
Choose a preferred venue/tutoring option
Select a Time and Venue *
Attendance & Payment plans
Tick options below as applicable *
Required
Method of Payment *
Permissions (please select)
I give permission for my child to be photographed⁄ videoed while at CompuTech Club. I understand these may be used for learning journals, promotional material or as part of the programme. *
I give permission for my child to watch the occasional educational/instructional video under supervision *
I give permission for my child to be given USB flash drive by CompuTech Club for the purpose of saving files/work done at the Club *
I give permission for my child to be photographed⁄ videoed by parents on special occasions such as birthdays or parties *
I give permission for my child to be taken for emergency treatment if required and I accept responsibility for any expenses incurred. *
Privacy Statement and Parent Declaration
The information collected on this form is for the purpose of providing safe and efficient operation of the CompuTech Club programmes. All personal information will be destroyed at the end of your child’s time at CompuTech Club unless you have requested future activities information. Child's information provided on this form will be used only in accordance with the Privacy Act 1993.You have the right to access and request correction of any personal information we hold about you or your child.
I, ___________ Parent/Guardian declare that the above information is correct to the best of my knowledge. *
Parent/Guardian Signature *
Required
Date *
MM
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DD
/
YYYY
Discounts and gift cards
Register two or more children and get 10% off (i.e. pay 180 for two children)
Refer someone for registration and get a $20 gift card
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