Connected Kids
Registration Form

Welcome!

This is where you can register yourself and your child or children for the next Connected Kids Play-Workshop..

Workshop Dates:

Saturday, 1st August 2020

10.00am to 12.00pm for 7 - 12 year old children
One Parent or grandparent is invited.

Follow-up session Saturday, 8 August, 10 - 11am

Location: Private residence, Bellerive

Fee: Any donation accepted

(Usual fee is $80 per family, however I'm happy to receive whatever you can afford during this pandemic disruption) Includes both sessions and unlimited follow-up support.

Any Questions? Please feel free to contact me.

Please send your chosen donation via this secure PayPal button before completing the form below

Connected Kids, Empowered Parents Webinar Workshop Registration

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

Participating Child/Children's Name(s) and Age*

E-Mail Address*

City*

State/Prov*

Mobile or Phone number*

Please choose *

	I give permission for my child's photo to be published online for promotional purposes
	I DO NOT give permission for my childs's photo to be published

My Donation is $*

Questions or Comments

By clicking the "Count Us In" Button below, you agree that you have read, understand and agree to the Participants Agreement at the foot of this page and that you have made a confidential 'individual affordable payment' as requested above*

PARENT/ GUARDIAN PERMISSION AND RELEASE:

I hereby grant permission for the child under my care to attend and participate in the Connected Kids class. I understand that Michael Taylor, and/or his employees will provide supervision for all activities and make sure that every reasonable effort will be made to ensure the safety of all participants

(Michael Taylor has a current Working With Vulnerable People - Child Related Activity registration number 075951293 and is also a Registered Teacher in Tasmania, Australia.)

I release Michael Taylor, his employees or volunteers from any liability or illness to my child.

I understand that Michael Taylor, and anyone associated with this work, inclusive of, but not limited to The Reconnection and Reconnective Healing, are neither diagnosing nor treating specific health challenges. I acknowledge that I am solely responsible for seeing to and continuing with my own and my child's own medical treatment and care.

Connected KidsRegistration Form

Connected Kids, Empowered Parents Webinar Workshop Registration

Connected Kids
Registration Form