KickStart Rego

KickStart Rego

Fridays 5pm to 6pm during school terms
Have you previously registered your child/ren in term 3?

yesno
Please enter your child/ren name and then complete PAYMENT before submitting.
Select how many children you are registering
Child 1*

First NameLast Name
Date of Birth*

MonthDayYear
Date
School Year*

Year 1Year 2Year 3Year 4Year 5
School attends:*
Child 2*

First NameLast Name
Date of Birth*

MonthDayYear
Date
School Year*

Year 1Year 2Year 3Year 4Year 5
School attends:*
Child 3*

First NameLast Name
Date of Birth*

MonthDayYear
Date
School Year*

Year 1Year 2Year 3Year 4Year 5
School attends:*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information*

First NameLast Name
Email*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Emergency Contact (different contact to parent/guardian information already listed)*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship*

ParentGrandparentFamily RelativeFamily Friend
Is there anything we need to know about your child/ren? (such as allergies or medications)
Media Declaration
Photos and/or videos may be taken of your child/ren during KickStart. You have given your permission for these to be used for Swansea Baptist Church's social media and future promotions by registering your child/ren. Please note that we do not use names unless permission has been sought prior.
Medical treatment declaration
Please note that all care is taken with your child/ren during KickStart. Basic first aid may be performed on site and medical professionals will be contacted as required with consultation with primary care giver.
Please ensure you complete the payment before submitting form.

Term Fee*

KickStart Term

$20.00AUD Quantity

Enter coupon

Total

$0.00AUD

Credit Card

Should be Empty:

KickStart Rego

Please enter your child/ren name and then complete PAYMENT before submitting.

Media Declaration

Medical treatment declaration

Credit Card