Godzone New Registration

First Name *

Last Name *

Preferred Name

Date of Birth *

School Grade

Gender *

Medical Alert

Dietary & Other Health Concerns

Ambulance Cover *

Home Address *

Home Address Line 2

Home City *

Home State *

Home Postcode *

Parent First Name *

Parent Mobile Number *

Parent Last Name *

Parent Email Address *

This must be someone other than the parent listed above.

Emergency Contact Name *

Emergency Contact Relationship (to child) *

Emergency Contact Mobile Number *

Person affirming guidelines *

Behaviour and Photography Guidelines *

I have read and understand the Behaviour Guidelines

I give permission for my child to be photographed and/or filmed for promotional purposes while participating in the program

I give permission for photos and or footage of my child to be used online for promotional purposes