First Name * |
Last Name * |
Date of Birth * |
Gender * |
Address 1 * |
Address 2
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City/Town * |
Postcode (BT) * |
EMERGENCY CONTACT DETAILS |
Contact name * |
Relation to Child * |
Mobile Telephone Number * |
Email Address * |
Repeat email * |
MEDICAL DETAILS |
Please use the following space to state, in confidence, any health or other matters concerning your child about which we should be aware e.g. allergies, asthma, etc. Please also indicate if your child is receiving any medication, with details and dosage and any specic dietary requirements.
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PHOTOGRAPHY AGREEMENT |
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DECLARATION In the event of an accident I hereby give my consent for a trained member of staff to administer first aid. In the event of any emergency, if my emergency contact or I cannot be reached, I hereby give my consent for my child to be transported to hospital
and/or given any medical, surgical or dental treatment, including general anaesthetic, as considered necessary by the medical authorities present.
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* |
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Select days attending * |
Promotional code |
* |