Pre-teen and Teen Girls Program
Registration of Interest
Participant details
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
Phone number
*
Format: 0000 000 000.
Email address
*
Preferred method of contact
*
Phone call
Email
SMS
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Program preference
School Holiday Program
Term 1
Term 2
Term 3
Term 4
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Signature
Date
/
Day
/
Month
Year
2 digit day, 2 digit month, 4 digit year
Date
Name of Signatory
Relationship to Participant
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