Social Thinking Program
Registration of Interest
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Date of birth
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Age
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Name of parent/carer
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First Name
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Format: 0000-000-000.
Preferred Method of Contact
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Program preference
School Holiday Program
Weekly Program - Term 1
Weekly Program - Term 2
Weekly Program - Term 3
Weekly Program - Term 4
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Signature
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Day
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Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Name of Signatory
Relationship to Participant
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