VIP Kids Club Holiday Program

Choose Event

First Name *

Date of Birth *

Gender *

Home Address Line 2 *

Last Name *

Age *

Home Address *

Home City *

Any medical information we need to know about

Food allergies / intolerances

Behavioural / learning needs we need to know about

First and Last Name *

Mobile Number *

Relationship to child *

Email Address *

Caregiver Address *

Same as above?

Yes

E.C. 1 Relationship to child

E.C. 1 Name

E.C. 1 Phone

E.C. 2 Relationship to child

E.C. 2 Name

E.C. 2 Phone

My child/children will be attending (tick all that apply)...(please note that the program is designed to build on the previous day's content) *

Tuesday 7th July 9:30am to 12:30pm

Wednesday 8th July 9:30am to 12:30pm

Thursday 9th July 9:30am to 12:30pm

I give permission for my child/children to attend The VIP Kids Club Holiday Program hosted by Living Waters Christian Centre *

Yes

I give permission for my child to be in photograhs for public use. *

Yes

Any additional things you'd like us to know about your child