Summer Holiday Program Registration Form

Summer Holiday Program Registration

Due to Covid-19 restrictions places in this program are limited. On the day attendees will be asked to sign in via QR code before entering If you are feeling unwell or showing any minor Covid related symptoms please refrain from attending.
Particpant Information
Name *

First Name Last Name
School Year *
Gender *

Male Female Non-Binary
E-mail *
Programs you would like to register for *

(Full - Waitlist only) Monday 18 Jan 2 – 4pm: Smash! Game Socials Tuesday 19 Jan 2 – 5pm : Tie-dye & Badge making day Wednesday 20 Jan 2 – 4pm: Balmoral Beats (Full- Waitlist only) Thursday 21 Jan 2 – 5pm: Upcycle Fashion - Embroidery Workshop Friday 22 Jan 4– 8:30pm: Movie Marathon Night Wednesday 27 Jan - 2pm - 4pm Beyond! Day 1 - Aboriginal Workshop Thursday 28 Jan - 2pm - 4pm Beyond Day 2 - M.A.D Therapy Friday 29 Jan 11am - 3pm: Beyond Day 3 -Startup Skills Workshop
Emergency Contact Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Allergies & Dietary Preferences
Do you have any allergies that we should be aware of? *
What is your dietary preference?

Vegetarian Vegan No preference
Other
How did you hear about our program? *

Instagram Facebook Mosman council events page
Do you consent to photographs or video of you appearing in Mosman Youth/Mosman Council promotional publications &/or media? - if you are under 18 you must have parental permission *

Yes No
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Summer Holiday Program Registration

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