Champion's Challenge Registration 2020

Please fill in this form to book a place for your child. Please use a separate form for each child.

Basic Information

Child's Full Name *

First name

Last name

Gender *

Date of Birth *

School

Dates

Will your child be attending all five days of the Champion's Challenge Programme?

Whole Week *

If your child cannot attend all five days, please select the days they can attend below.
(If you answered 'Yes' to the previous question you can skip this section)

Monday

Tuesday

Wednesday

Thursday

Friday

Does your child have any allergies?

Allergies

Parent's/Guardian's Contact Info

Parent's/Guardian's Full Name *

Parent's/Guardian's Contact Phone *

Parent's/Guardian's Email address *

Address

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

I give permission for my child to attend the Champion's Challenge Programme *

In the unlikely event of illness or emergency, I give permission for any appropriate first aid to be given by the nominated first-aider. In an emergency, and if I cannot be contacted, I am willing for my child to be given hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.

I agree *