Social Thinking Holiday Program
Registration of Interest
Name
*
First Name
Last Name
Date of birth
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Age
*
Name of parent/carer
*
First Name
Last Name
Email
*
Phone Number
*
Format: 0000-000-000.
Preferred Method of Contact
*
Phone
SMS
Email
Back
Next
What is your date preference for the program?
Tuesday 22nd - Thursday 24th September
Wednesday 30th - Friday 2nd October
Please note that while we will do our best to accommodate your preference, they are not guaranteed. Final dates and times will be confirmed closer to the start of the program
Back
Next
Signature
*
Date
*
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Name of Signatory
*
Relationship to Participant
*
Submit
Should be Empty: