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* 1. Parent / carer full name:

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* 2. Parent / carer phone number:

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* 3. List your child/ren's full name/s:
You are able to list up to two children below.

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* 4. What school does your child/ren currently attend?

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* 5. Which workshop would you like your child/ren to attend?

Years 3 and 4 – Wed 8th October (suitable for 8 – 11 years*)

Years 5 and 6 – Thurs 9th October (suitable for 10 – 13 years*)
*discussion about the most suitable classes can be arranged if required.

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* 6. Will your child bring a friend along?

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* 7. Do you wish for your child/ren to participate in the lunchtime excurision
activity [either Flip Out or Strike (for either bowling, laser tag or mini golf)] at Charlestown Square. An extra $12 per child will be charged for activity participation.

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* 8. List any medical conditions and diagnoses we need to be aware of:

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* 9. Specify dietary or medical requirements, or do you have any further comments or questions?

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