Kids Workshop Registration

	YOUR CONTACT DETAILS

	First Name*

	Surname*

	Email Address*

	Contact Phone Number*

	Which session/s are you booking?* Please list all the dates that you wish your child/ren to attend

	CHILDREN'S DETAILS* Name, Age and Gender of each Child attending

	Is there anything else you'd like me to know about your child/ren?

1.	FOR SESSIONS AT BLACKWOOD ONLY If your child is to attend a group at Blackwood, please provide the following information...

	Describe any allergies or current illness patterns that your child has, and any medications your child is taking for those…

	Are there any foods that your child should not eat? Please describe…

	Does your child have a fear of, or allergy to, Dogs or Cats? Please describe

	Would you like to receive the Aquarian Blessings FREE Newsletter?* The Aquarian Blessings Newsletter is issued 4 times a year, by email, in pdf format. It contains lots of interesting articles & information about the ways in which we can create great health and a wonderful life. It will also keep you informed about changes to my services, specials, new products, upcoming workshops and other healing & self-empowerment activities… please answer Yes or No…

YOUR CONTACT DETAILS