Western Student Connections
Creative Kids Robotics and Coding Workshops
2022
Workshop Application Form

Morning tea and lunch is provided for each participant

Date Workshop Ages Time  
Wednesday 13th April 2022 (CANCELLED) Ozobots and Spheros 8 - 15 years 9:00am – 3:00pm Make sure you have applied for a Creative Kids Voucher FIRST
Fill in the Form below to apply for your child to attend a workshop
Wednesday 20th April 2022 Scratch Coding 8 - 15 years 9:00am – 3:00pm

Please complete the Workshop Application Form below and click the SUBMIT button
If you prefer, you can print the Form and fax (02 6885 6199) or deliver the Form to 2/12 Blueridge Drive or Email reception@wsc.edu.au
 Download the Application Form

Please complete all sections of this form:

Section 1 Course Information (please select ONE):

1. Course Name: Creative Kids Robotics and Coding Workshop
2. Date and workshop (please select ONE):

Wednesday 13th April 2022 - Ozobots and Spheros at Dubbo
Wednesday 20th April 2022 - Scratch at Dubbo

Section 2 Parent / Carer Details:

3. Parent Name:
4. Relationship to child:
5. Address:
6. Phone Number:  
7. Mobile Number:  
8. Email Address:

Section 3 Child's Details:

9. Child's Full Name:
10. Age: 11. Date of Birth:
12. Gender: FemaleMale
13. School:
14. School class:
15. Is the participant Aboriginal and/or Torres Strait Islander? NoAboriginalTorres Strait Islander

Section 4 Creative Kids Voucher Details:

16. Voucher Number:

Section 5 Other Information:

17. Does the participant have a disability, impairment or long-term condition? Yes No
If yes, please mark any applicable box
Vision Hearing Physical Intellectual Medical Mental Health Learning Other
Please provide further information:

18. Does the participant require assistance because of this disability, impairement or long-term condition? Yes No
If yes, please contact Western Student Connections to discuss.

19. Special dietry requirements / allergies:

Section 6 Declaration

Please check each box:

I understand that workshop numbers are limited, that this Application does not guarantee a place in the course and that I will receive confirmation on receipt of the Application
I will notify Western Student Connections of any circumstance which may pose a risk.
I will notify Western Student Connections if participant is unable to attend. Failure to notify will mean workshop fee must be paid
Workshop cost is $100.00 (incl. GST) per participant, and may be paid using the Creative Kids Voucher.
If paying cash, payment must be received at least one week before workshop date.

We will be in touch by email to confirm attendance and provide further information