JEZA Scooter Workshop-Registration

Come learn scooter skills & tricks with Jeremy Fiedler

The Regional Council of Goyder and YAC would like to welcome you to the December 21, Youth Activity Program. There are 2 scooter workshops available.
Session 1- 1.30-2.30pm (primary school ages 5-12yrs)
Session 2- 2.30-3.30pm (high school + 12-24yrs)

Bring along your scooter, helmet and safety gear.

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* 1. Please register Participant #1 to one session only:

Session 1- 1.30pm (primary school ages)

Session 2- 2.30pm (high school - 24years)

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* 2. Participant #1- Details

Name

Address

City/Town

State/Province

Phone Number (of Parent/Guardian if under 18)

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* 3. Participant #1 Date of Birth (DOB)

Please provide details:

Date

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* 4. Please register Participant#2- to one session below:

Session 1- 1.30pm (primary school ages)

Session 2- 2.30pm (high school - 24years)

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* 5. Participant #2 Details

Name

City/Town

Phone Number of Parent/Guardian (under 18)

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* 6. Participant #2 Date of Birth (DOB)

Please provide details:

Date

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* 7. Please register Participant#3- to one session below:

Session 1- 1.30pm (primary school ages)

Session 2- 2.30pm (high school - 24years)

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* 8. Participant #3 Details

Name

City/Town

Phone Number of Parent/Guardian (under 18)

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* 9. Participant #3 Date of Birth (DOB)

Please provide details:

Date

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* 10. If you have more than 3 children (from one family) to register you can use another email and start registration process again. OR- complete this form and then contact council directly with the further names and details via phone. Call on 8892 0100 or via Sport & Recreation Development Officer- Samantha on 0429 694 169

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* 11. Parent /Guardian/ Emergency contact Details

Name

Email Address of Parent/Guardian (under 18)

Phone Number of Parent/Guardian (under 18)

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* 12. Have you registered for any other Holiday Activities listed on the Council Website? Please check the boxes below-

Lolly Jar Circus workshops- All-Abilities circus skills- Monday 13th December

All Aboard Skateboard Sessions- Wednesday 15th December

22TOO Gymnastics- Ninja Warrior, Tiny Tots, Junior Parkour, Fun Acrobatics- 16th & 17th December

None of the Above

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* 13. Conditions of Registration

You have downloaded and completed the JEZA Waiver form to return at the start of the session

Agree to behave accordingly and in line with instructions of the session presenter?

Agree to maintain the safety of yourself and others during the session