KuCoNa Youth Programme Registration 2026
Complete the registration details for your child and confirm your consent for participation and emergency care.
Child Details
Child full name
*
First Name
Middle Name
Last Name
Surname
*
Date of birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Age
*
Gender
*
Male
Female
Non-binary
Prefer not to say
Other
Grade/Class
School name
Home address
*
ID/Birth certificate number
Parent/Guardian Details
Parent/Guardian Full Name
*
First Name
Middle Name
Last Name
Relationship to Child
*
Please Select
Mother
Father
Guardian
Grandparent
Sibling
Other
ID Number
*
Phone / WhatsApp
*
Please enter a valid phone number.
Format: (000)-000-0000.
Email Address
*
example@example.com
Address if Different from Child's Home Address
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship to Child
*
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Health and Special Needs
Does the child have medical aid?
*
Yes
No
Medical Aid Provider
Medical Aid Number
GP/Primary Doctor
Doctor or clinic phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Allergies and details
Medical conditions and details
Medication, special needs, and support required
Programme Details
Program Year
*
Programme Selection
*
Monday Buildstem Young Engineers Programme
Tuesday Arts and Crafts
Wednesday Nature Club
Wednesday Bird Club
Thursday Nature Credit Adventures Club
Friday Eco Youth Circle
Preferred Start Date
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Programme Intensity
Full Programme
Partial Programme
Flexible Attendance
Other
Preferred Attendance Level
Please Select
Full Day
Half Day
After School
Weekend Only
Other
Preferred Days
Monday
Tuesday
Wednesday
Thursday
Friday
Previous Programme Year
Programme Notes
Activities and Transport
Drop-off Time
*
Hour Minutes
AM
PM
AM/PM Option
Pick-up Time
*
Hour Minutes
AM
PM
AM/PM Option
Transport Method
*
Parent/Guardian Drop-off
Walk/Cycle
School Bus
Public Transport
Other
Independent Travel Consent
Yes
Consent and Permissions
Consent to participate in programme activities
*
Yes
No
Permission for photos and video use
*
Yes
No
Permission for emergency medical treatment
*
Yes
No
Consent to be contacted about programme updates
*
Yes
No
I confirm that the information provided is accurate and complete
*
I confirm this statement
Declaration and Code of Conduct
Code of Conduct Acknowledgement
*
I acknowledge that my child and our family will follow the programme code of conduct
Parent/Guardian Declaration
*
I confirm that the information provided is true and complete
I understand and accept the programme terms and responsibilities
Typed Signature
*
Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Registration
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