Registration Form

By completing the registration form we will register your child. You will be asked to sign the form submitted on the first visit. Information collected will be used for health and safety purposes.

Child's First Name

Child's Surname

Date of Birth

School

1. Parent/Guardian details:

1. Title

1. First Name

1. Surname

1. Home Address

1. Email Address

1. Does the child normally live at this address?

1. Does this person have parental responsibility for this child

1. Relationship to the Child

1. Home telephone number

1. Mobile number

1. Work number

2. Parent/Guardian details:

2. Title

2. First Name

2. Home Address

2. Does the child normally live at this address?

2. Does this person have parental responsibility for this child

2. Relationship to the Child

2. Home number

2. Mobile number

Work number

Emergency Contact Details

Name

Emergency Telephone Number

Emegency Mobile Number

Address

Relationship to the child

Child's Doctor

Name of Doctor

Doctor's Telephone number

Doctor's Address

About your child

Health Issues

Regular medications

Registration Form

Registration Form

About Us

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