Connected Kids
Registration Form

Welcome!

This is where you can register yourself and your child or children for the next Connected Kids Class in Tasmania or online.

Workshop Dates:

Hobart - Monday, 8th July 2019

10.00am to 12.30pm for 5 - 12 year old children
Parents or grandparents are invited.

Location: Private address in South Hobart Tasmania.

Fee: As advised

New!!
Online classes are now available! If you have access to video calls via Skype/WhatsApp etc. anywhere in the world, we can arrange a workshop for you and your child/children.

Any Questions? Please feel free to contact me.

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.

In case of illness or injury, if I can not be reached after reasonable efforts, I give Michael Taylor the authority to act on my behalf for the care and treatment of my child.

Connected KidsRegistration Form

Connected Kids, Empowered Parents Webinar Workshop Registration

Connected Kids
Registration Form