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Little Gecko School Holiday Workshop
ONE EXCITED GECKO ($300)
*
One Excited Gecko ($300)
WHO WILL BE JOINING US?
*
First and Last Name
AGE
*
DOES THE PARTICIPANT HAVE ANY MEDICAL CONDITIONS, ALLERGIES OR LEARNING DIFFICULTIES OF WHICH WE SHOULD BE AWARE?
*
YES
NO
PLEASE EXPAND TO ENSURE OUR TEACHING ARTISTS HAVE ALL RELEVANT INFORMATION
PHOTO RELEASE
*
I consent for Barking Gecko Theatre, its sponsors and partners, to use images/ video footage of my child/ me for the purpose of use in any Barking Gecko publication (all media, including Internet), exhibitions, marketing, publicity and documentation. I understand that this may include my child’s / my first name, the place and date of the image for publication without compensation to my child/ me.
YES
NO
PARENT OR GUARDIAN'S NAME
PRIMARY PHONE NUMBER
BACK UP PHONE NUMBER
YOUR PREFERRED EMAIL ADDRESS
STREET ADDRESS
PAYMENT
As we are in the middle of changing payment partners, please indicate whether you would prefer to pay by electronic fund transfer or by credit card
EFT (electronic fund transfer)
Credit card