Application to join the Culture Dose for Kids Program

Please answer the following questions to help us determine your child's suitability for the Culture Dose for Kids program. This brief questionnaire should take about 2 minutes to complete.

We will need your contact details to let you know whether your application is successful:

Child's first name

Parent/carer's first name

Parent/carer's email address

Mobile number (if we have any questions for you)

Type the characters you see in the picture above: *

Regenerate security key