Workshop Registration Form

Parent/Guardian names: (required)

Your email (required)

Please confirm your email (required)

Your phone

Would you like to receive follow up emails?
YesNo

Is this your first 'Sparky and Shady' event?
YesNo

How exactly did you find out about 'Sparky and Shady'?
(This will help us reach more parents like you!)

Child's Details

Name

Age

Date of birth

School

Year at school

Aspirations for your child?
(What are you hoping to gain from the program?)

2nd Child's Details (if applicable)

Name

Age

Date of Birth

School

Year at school

Aspirations for your child?
(What are you hoping to gain from the program?)

3rd Child's Details (if applicable)

Name

Age

Date of birth

School

Year at school

Aspirations for your child?
(What are you hoping to gain from the program?)

Special requirements:
Do you or your child/ren have any special requirements?
(e.g. physical access, allergies, intolerances, additional needs or other concerns?)

Promotional permission:
Do you and your child give permission for approved photos to be posted on:

Social Media (e.g. FB, Instagram)?
YesNo

Website (sparkyandshady.com)?
YesNo

Print media (e.g. Newspaper)?
YesNo

Parent/Guardian signature:
NB If filled out online a typed signature is fantastic.

Date

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