Register Interest - Kidz Retreat

Child's Details

Child's Full Name*

Date of Birth*

Gender*

What day/days does your child require care?*

Anticipated Commencement Date*

CRN*

Would you like to add another child*

Child's Full Name

Date of Birth

Gender

What day/days does your child require care?

Anticipated Commencement Date

CRN

Reason for care?*

Reason

Arrange a time for a Tour of our facilities*

Please choose 2 days that will suit you for a tour*

Please select a time that would suit

Parent/Guardian Name*

Date of Birth*

CRN

Phone Number*

Email*

How did you hear about our Centre?*

Please Specify

Please include some further details about how you found us as it helps us with our marketing efforts.