Registration Form

[row]

[span6]One Day Retreat – Saturday, 8th February 2020 

Charles Sturt University Campus, Canberra

15 Blackall St, Barton ACT 2600

[/span6]

[span6]

[/span6]

[/row]

[row]

    Please use separate application for each kid

     Parent or Guardian Name

    Contact Number

    Email

    Relation to Child

     Child Full Name

     Gender

    MaleFemale

     Any Allergies

     Any medication details in case of emergency

    Date of Birth

    Suburb

     Referred By

     

     

    [/row]