REGISTRATION FORM
Registration for Digital Technologies After School Programme
Child(ren)
Number of children enrolling *
Child’s Full name (#1) *
Your answer
Age
Your answer
School ; Year at school *
Your answer
Child’s Full name (#2)
Your answer
Age
Your answer
School ; Year at school
Your answer
Other child(ren): Name, age & school year
Your answer
Parents/Guardians
Name (#1) *
Your answer
Relationship to child
Address *
Your answer
Email *
Your answer
Phone Work/Mobile *
Your answer
Name (#2) *
Your answer
Relationship to child
Email *
Your answer
Phone Work/Mobile *
Your answer
Emergency Contact
Please provide contacts of someone we can contact if we are unable to reach parents/guardian
Full Name
Your answer
Address
Your answer
Phone
Your answer
Times & Venues
Choose a preferred venue (s)
Select a Time and Venue *
Attendance & Payment plans
Tick options below as applicable *
Required
Transport to CompuTech Club centres (Option currently available to Ilam and Papanui branches only)
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. *
Your answer
Parent/Guardian Signature *
Required
Date *
MM
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DD
/
YYYY
Trial Sessions and Discounts
Book for a whole term of 9-10 weeks and get 40% off the $100 term fee
Register one child and get another child registered for 50% off
Refer someone for registration and get a $20 gift card
Book to attend an assessment or trial session
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