Kids Music and Moves

Parent first name:

Parent last name:

Caregiver/nanny name (if attending class):

Mobile phone number:

Email:

Address:

Suburb:

State:

Postcode:

Preferred start date:

Preferred class:

Goodwood Community Centre - Wednesday 9.30-10.15am
Goodwood Community Centre - Wednesday 10.30-11.15am

Child's first name:

Child's last name:

Is child male or female?

Male
Female

Child's date of birth:

Child's age at start of term:

Name & age of siblings

I give my consent for Kids Music and Moves to use any photographs & video taken of me and my child during the course of the term for future promotions in any media & I understand there will be no financial compensation.

Yes
No
Please note: Lizzie will ask if children are allowed to be in the video before each recording. If the accompanying carer allows a child onto the video mat for a recording, that will be considered consent on that occasion.

Does your child have an allergy, disability or medical condition that will affect their participation?

Yes
No

If yes, please provide details:

Message:

Please keep an eye on your inbox/junk folder for an email from lizzie@kidsmusicandmoves.com

EnrolLment form: