Register for Incredible Years

Register for Incredible Years

If you would like to receive information about our next courses please register with us and you will then be sent upcoming course information as soon as we have the details confirmed.

Incredible Families collects and stores information from this form, and any surveys completed while attending the course, in accordance with the Privacy Act 1993.

Any information used for statistical or research purposes will not be published in a form that identifies any individual. If you have any questions or complaints please call Diana 027 474 5869.


Parent/Caregiver #1

Caregiver's name:
(required)

Age:

Attending course:

Access to child(ren):

Ethnicity:
(collected for funding purposes)

Parent/Caregiver's Contact Details

Day:

Evening:

Mobile:

Email address:

Postal address:
(including post code)

 


Parent/Caregiver #2

Caregiver's name:
(required)

Age:

Attending course:

Access to child(ren):

Ethnicity:
(collected for funding purposes)

Parent/Caregiver's Contact Details

Day:

Evening:

Mobile:

Email address:

Postal address:
(including post code)

 


Children

Child's first & last names:

Child's ethnicity:
(collected for funding purposes)

Date of birth:

Early Childhood centre or school child attends:

Do any of your children have a formal diagnosis? (e.g. ADHD, developmental delay)

Child's name:

Diagnosis: