Kids Club Registration Form

Parent of Child(ren)

First Name *

Last Name *

Mobile Number *

Email Address *

Home Address *

Home City *

Emergency Contact

Someone different from adult registering child

Full Name *

Phone *

Relationship to child *

Child 1

First Name *

Last Name *

Gender *

Date of Birth *

Year at School

Child 2

First Name

Last Name

Gender

Date of Birth

Year at School

Child 3

First Name

Last Name

Gender

Date of Birth

Year at School

Child 4

First Name

Last Name

Gender

Date of Birth

Year at School

Allergies or other illnesses we should be aware of:

Photograph permission

By checking this box, I give permission for leaders to photograph my child/ren within Kids Club and to use these photos for the purpose of Kids Club activities

By checking this box, I give permission for leaders to use any photographs taken for the purposes of advertising Kids Club

How did you hear about Kids Club?

Thank you for registering your child(ren). We look forward to seeing you soon at Kids Club :).