Marketplays Kids Club - Bendigo Marketplace

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Email
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Guardian Email Address*
Guardian First Name*
Guardian Last Name*
Suburb*
Postcode*
Child 1 First Name*
Child 1 Last Name*
Child 1 Gender (please select)
Child 1 Birthday
DD slash MM slash YYYY
Child 2 First Name
Child 2 Last Name
Child 2 Gender (please select)
Child 2 Birthday
DD slash MM slash YYYY
Child 3 First Name
Child 3 Last Name
Child 3 Gender (please select)
Child 3 Birthday
DD slash MM slash YYYY
Child 4 First Name
Child 4 Last Name
Child 4 Gender (please select)
Child 4 Birthday
DD slash MM slash YYYY
Child 5 First Name
Child 5 Last Name
Child 5 Gender (please select)
Child 5 Birthday
DD slash MM slash YYYY
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