STEAM Summer Programme Registration and Consent form

STEAM Summer Programme Registration and Consent form

Choose your venue and provide participant details, contact information, and any personal or medical requirements.
Please select the venue you wish to attend
If no places are available at your preferred venue please email kelly.mallon@armaghbanbridgecraigavon.gov.uk to be added to the waiting list.
Participant's Name

First NameLast Name
Participant's Date of Birth

MonthDayYear
Date
Participant's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are there any personal, medical requirements or allergies that we need to be aware of?
Parent / Guardian Contact Name

First NameLast Name
Relationship with the participant
Parent / Guardian Contact Phone Number
Please enter a valid phone number.Format: 00000000000.
Alternative Contact Phone Number
Please enter a valid phone number.Format: 00000000000.
Parent / Guardian Email Address
example@example.com
Any other Information: Please note below any other information that you feel is relevant.
Would you like to hear about events and courses from our Community Development Department?
Do you give permission for photography/videos to be taken of your child during the programme and used for promotional purposes?
Should be Empty: