CHILDS PERSONAL DETAILS
Date of Birth dd/mm/yyyy
PARENT / GUARDIAN DETAILS
Relationship to Child
Address (Leave blank if same as child)
Mobile - Required
Email - Required
Do you give permission for use of photos and/or videos that we take for advertising on our wesbite or facebook page?
Do your child suffer from any of the following?
Does your child take any Medications?
If yes please list medications
Please list any previous injuries
Special instructions regarding your child?
Doctor / GP
I declare the information I have provided is true and correct. I agree to the terms and conditions set out in this agreement
Parent / Caregiver Signature (Type Name)
Date : dd/mm/yyyy
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