Kids Konnect Registration

Please fill out this form and click submit.

Child's Name

*

Child's Date of Birth

*

Address

*

School

*

Please select one option.

Coolgardie Boulder Goldfields Baptist College East Kalgoorlie Kalgoorlie Central North Kalgoorlie Hannans South Kalgoorlie St Mary's St Joseph's Kambalda WDHS Kambalda East O'Connor Other

Grade

*

Please select one option.

Kindy Pre-Primary 1 2 3 4 5 6

Parent/Guardian Email

*

This address will receive a confirmation email

Parent/Guardian Phone

*

Name of Parent/Responsible Adult bringing child to Kids Konnect

Allergies/Alerts

Please select all that apply.

Nuts Bee stings Asthma Epilepsy Court Order Other

Any other information we need to know?

Description

Please fill out this form and click submit.

Please Fix the Following

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