Music & Dance Application Form

Parent/Carer Details

Child Details

Is your child involved in any other KidzWish programs?
KidzWish aims to help children 0-18 who are sick, disadvantaged or have a disability. For statistical purposes, please tell us which category your child fits into.


My child/children are available to attend

Emergency Contact Details

Getting to know your child

Medical History

Does your child have any of the below

Additional Information

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