CL&AG - Registration Form - Brick by Brick T4

Child's Full Name*

Age*

Parent or Guardian Contact Name*

Parent or Guardian Contact Number*

Email Address*

Please select a challenge:*

Challenge 1 (13 & 20 Oct)Challenge 2 (27 Oct & 13 Nov)Challenge 3 (10 & 17 Nov)Challenge 4 (24 Nov & 1 Dec)

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