CL&AG - Registration Form - School Holiday Program

Child Full Name*

Child Age*

Parent or Guardian Contact Name*

Phone Number*

Email*

PHOTO CONSENT: I give consent for images to be taken of my child and for these images to be used, modified, and distributed by the Shire of Carnarvon.*

YesNo

OPTIONAL QUESTION: Are there any medical conditions or medication requirements we should be aware of? (e.g. food allergies etc.)