Secret Agent Society – registration form About YouYour ChildEducationHealthBehaviour Additional Information Parent/Legal Guardian – Name * Parent/Legal Guardian – Name First Name First Name Last Name Last Name Address * Address Address Address City City State State Postcode Postcode Phone * Email * Other Parent/Guardian Name Other Parent/Guardian Name First Name First Name Last Name Last Name Other Parent/Guardian Phone Other Parent/Guardian Email Let me know your preference of how your child will attend the SAS Child Club Meetings. * In person only Online only I am flexible, book me in for whatever is available Let me know your preference of days/times. Please refer to website for most up to date information. * Tell us the days and times that you and your child are available. We currently run sessions Mon-Thurs at approx 4:30 and 6:00pm AEST. Saturday online sessions are by request. In person sessions are currently run on Saturday afternoons at 3pm. Does your child have access to a device larger than a phone at home? * Yes No Please rate how confident you are in your ability to support your child’s social and emotional development * 0 1 2 3 4 5 0 is not at all confident, and 5 is very confident. If you are human, leave this field blank. Next
