Wild School Programme Enrolment

Wild School Programme Enrolment

Enrolment Form for Our One Day Wild School/School Holiday Programmes - 5- 10 year olds
Which programme do you wish to enrol in?
Child's Name

First NameLast Name
Age
Birth Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
School
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 1

First NameLast Name
Mobile Phone Number

Area CodePhone Number
Other Contact Phone

Area CodePhone Number
Email
example@example.com
Parent/Guardian 2

First NameLast Name
Mobile Phone Number

Area CodePhone Number
Other Contact Phone

Area CodePhone Number
Email
example@example.com
Emergency Contact (Additional to Parents, in case we can't get in touch with you. This person will be responsible for making decisions for your child and/or collecting if required).

First NameLast Name
Phone Number

Area CodePhone Number
Relationship to family
Other people who can collect your child
Please include full names & relationship to family
People who cannot collect your child (if applicable)
Please include full names & relationship to family
What strengths, interests and hobbies does your child have?
Does your child have any allergies or health needs that we should know about? Please describe
Does your child need support with: (select any/all that apply)

Other
If you selected "other" please describe
Does your child have any learning or behaviour needs that we should know about? Please describe
What are the reasons you would like your child to attend Wild School?
How did you hear about us?
Please read the following pages for details around participation, terms and conditions
Photo/Video Consent
Parent/Guardian Name

First NameLast Name
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Parent/Guardian Signature
Privacy Act 2020: The information you have supplied is necessary for the safe and efficient operation of WS. All personal information is held confidentially, and not shared with another party. You are welcome to review information held on your child at any time.
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