Enrolment Form for kids class

Enrolment Form for Laura’s Health & Dance Fitness Children's classes.
Child's Name:

First NameLast Name
Guardian's name
Email:
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Eir Code
Contact Phone Number

Area CodePhone Number
Child's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Does your child have any Learning Difficulties?
COVID-19 Questionnaire:In the last 14 days have you...1)Had any Covid-19 symptoms?2)Been in contact with any confirmed/ suspected Covid-19 cases?3)Have you recently travelled internationally?If you have answered 'YES' to any of the questions, please Do Not Attend any class and call your GP immediately !By Booking this class you are agreeing that you have answered 'NO' to all the questions above.
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Should be Empty: