Create Calm Mental Wellbeing Workshops

Parent Participant Information

Parent / Caregiver 1 Participating: Name

First NameLast Name

Parent / Caregiver 2 Participating: Name (only if participating)

First NameLast Name

Child Participating 1: Name

First NameLast Name

Child 1 Participating: Age

Child 2 participating: Will you be using a Creative Kids Voucher as part of the Payment?

If using the Creative Kids Voucher. a valid Voucher number is required and will need to be verified prior to acceptance into the workshop.

Child 1 Participating: Date of Birth

Date

Child 1 Participating: Creative Kids Voucher Number

Child 1 Participating: Gender

He/himShe/herTheyPrefer not to say

Child 1 Participating: Year

Child 1 Participating: School

Child 1 Participating: Please help us make every effort to prepare best to care for the health and wellbeing of your child. Please email through a Care/Management Plan/s as applicable to info@vividyou.net*

Child 1 Participating: Do we need to be aware of any illness or physical disability of the participant?

YesNo

Child 1 Participating: Do we need to be aware of any behavioural condition, mental health illness or intellectual disability of the participant? If Yes, please provide information to info@vividyou.net

YesNoOther

Participant 1: What should we know about food for your child?*

Child 2 Participating: Name

First NameLast Name

Child 2 Participating: Age

Child 2 participating: Will you be using a Creative Kids Voucher as part of the Payment?

If using the Creative Kids Voucher. a valid Voucher number is required and will need to be verified prior to acceptance into the workshop.

Child 2 Participating: Date of Birth

Date

Child 2 Participating: Creative Kids Voucher Number

Child 2 Participating: Gender

He/himHer/shePrefer not to say

Child Participating 2: Year

Child Participating 2: School

Participant 2: Please help us make every effort to prepare best to care for the health and wellbeing of your child. Please email through a Care/Management Plan/s as applicable to info@vividyou.net*

Child Participating 2: Do we need to be aware of any illness or physical disability of the participant?

YesNo

Child Participating 2: Do we need need to be aware of any behavioural condition, mental health illness or intellectual disability of the participant? If Yes, please provide information to info@vividyou.net

YesNoOther

Participant 2: What should we know about food for your child?

Parent/Guardian Information

Guardian/Parent 1: Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState

Postal Code

Parent 1: E-mail

example@example.com

Parent 1: Telephone number

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Emergency Contact Telephone number

How did you hear about this event?

Right to publish: During the day we like to take pictures to share with you and also to use in social media. Please advise if you agree to pictures being taken.

YesNo

Waiver: I agree to the above-mentioned participant taking part in all activities provided and hereby indemnify Vivid You and its staff of any claim or demand or action made commenced by the participant or any person against Vivid You in connection with any loss or damage suffered whilst participating in the programme. Should your child need assistance during the day, contact will be made to ensure the best for your child or children.

I agreeI disagree

Would you like to keep up to date on other events and information relating to supporting health and wellness.

YesNo

Event Payment

Friday, 24th February 2023 7-9pm

This is a Parent only event and is a pre-requisite for your child or children to attend the workshop on Saturday. Please nominate how many adults are attending from your family.

$35.00AUD Quantity

Saturday, 25th February 3-8pm

One Parent and One Child (aged 9+) - USE COUPON 1CALMKID100

$160.00AUD Quantity

Saturday, 25th February 3-8pm - 2nd Child

Second Child (aged 9+) - USE COUPON 1CALMKID100

$128.00AUD Quantity

Saturday, 25th February 3-8pm - Family

Family of 4 (2 Adults & 2 Children 9+) - USE COUPON 2CALMKIDS200

$300.00AUD Quantity

Friday, 10th March 2023 7-9pm

This is a Parent only event and is a pre-requisite for your child or children to attend the workshop on Saturday. Please nominate how many adults are attending from your family.

$35.00AUD Quantity

Saturday, 11th March 3-8pm

One Parent and One Child (aged 9+) - USE COUPON 1CALMKID100

$160.00AUD Quantity

Saturday, 11th March 3-8pm - 2nd Child 2

Second Child (aged 9+) - USE COUPON 1CALMKID100

$128.00AUD Quantity

Saturday, 11th March 3-8pm - Family 2

Family of 4 (2 Adults & 2 Children 9+) - USE COUPON 2CALMKIDS200

$300.00AUD Quantity

Enter coupon

Total

$0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Creating Calm - Mental Wellbeing