Registration Form

Child's Name

First Name

Last Name

Child's Date of Birth

Child's Address (inc postcode)

Child's Ethnicity

Doctor's name and surgery address

Doctor's Telephone Number

Child's Medical Conditions / Allergies

If yes, please give details:

Parent /Guardian Name

First Name

Last Name

Parent /Guardian Address (if different from child's)

Parent /Guardian Email

Parent/Guardian Mobile Number

(###)

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Emergency Contact (other than yourself)

Please include Name and Contact Number

Other notes:

I give consent for my child to be in occasional photos and videos taken during the classes for promotional purposes.