CL&AG - Registration Form - Brick by Brick T3

Child's Full Name*

Age*

Parent or Guardian Contact Name*

Parent or Guardian Contact Number*

Email Address*

Please select a challenge:*

Challenge 1 (28 Jul & 4 Aug)Challenge 2 (11 & 18 Aug)Challenge 3 (8 & 15 Sep)

Photo Consent - I give consent for images to be taken and for these images to be used, modified, and distributed by the Shire of Carnarvon.*

YesNo