Wacky Workshops Private Classes Registration Form

Wacky Workshops Private Classes Registration Form

Complete the form below and submit or call Tami on 0402732859
Name *

First Name Last Name
Gender *
Age *
Date of Birth *
School *
Grade *
Parent/carer name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
Email *
Emergency contact and phone number *

Name Phone Number
Preferred date/time of class
CREATIVE KIDS VOUCHER NUMBER (applicable to private classes only) or DISCOUNT CODE
Medical conditions/special needs
Special interests/talents of student
How did you hear about Wacky Workshops?

Friend Google Facebook Other
I am happy for Wacky Workshops to use photos of my child for promotional purposes with the understanding that no names will be used.Y/N *
I understand that all care will be taken but agree to hold Wacky Workshops harmless for any personal injuries that may occur during the workshop. *

Yes
Date
To secure your spot, please fill in your Creative Kids voucher number in the space above or direct deposit to Wacky Workshops, BSB: 062640, Account No: 10215645
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