Student Information Form

Please complete a new form for each child.

Student's first and last name:

Parent / Guardian email:

Student's Age:

Workshop selected:

Coding experience:

Duty of Care: Please share any information about the child being enrolled. Include behavioural, emotional, or intellectual needs, that will ensure our success in fostering an atmosphere of curiosity, creativity, and collaboration.

Emergency Medical Assistance: I acknowledge that if any child included in this enrolment form has been injured, or becomes ill whilst at StemGen or otherwise in StemGen's care, then StemGen will seek urgent medical, dental or hospital treatment or ambulance service; and I give consent to the carrying out of appropriate medical, dental or hospital treatment.

Yes, I agree to emergency assistance

Does the child being enrolled carry medication or have a medical conditions we need to be aware of?

Please provide details and bring Medical Action Plans to the first session. Leave blank if this does not apply to you.

Media Release Agreement: I agree that photographs and videos of children included in this enrolment form taken at StemGen may be used by StemGen for promotional purposes in its publications; on its website; on social media; in media activities; and for educational displays and in presentations at professional development courses and conferences.

Yes, I agree to give StemGen permission to use media No, I do not agree to give StemGen permission to use media

Parent/Guardian's name:

Parent/Guardian's mobile number:

Parent/Guardian's email:

Student Information Form

Complete payment to secure your place.