Gledowls Registration Form

Gledowls Registration Form
Owlet's Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Parent/Carer Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Home Phone Number*
Please enter a valid phone number.Format: 00000 000000.
Mobile Phone Number*
Please enter a valid phone number.Format: 00000 000000.
Work Phone Number*
Please enter a valid phone number.Format: 00000 000000.
Email*
example@example.com
2nd Parent/Carer Name

First NameLast Name
Home Phone Number
Please enter a valid phone number.Format: 00000 000000.
Mobile Phone Number
Please enter a valid phone number.Format: 00000 000000.
Work Phone Number
Please enter a valid phone number.Format: 00000 000000.
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Other named adults who are permitted to collect your child from club
Password to be used by named adults who are unknown to club staff *
Emergency Contacts
1st Emergency Contact Name*

First NameLast Name
Relationship to Child*
Emergency contact phone number *
Please enter a valid phone number.Format: 00000 000000.
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
2nd Emergency Contact Name*

First NameLast Name
Relationship to Child*
Emergency contact phone number *
Please enter a valid phone number.Format: 00000 000000.
Address*

Street Address

Street Address Line 2

CityState / Province

Post Code
Please indicate below any existing medical conditions/allergies *
For Example: Has Asthma, needs an inhaler or allergic to nuts
Any other information you feel may help us in caring for your child *
For Example: Has special education needs or lacks confidence in new places
Please tick the statements below that apply*

I agree to club staff administering first aid to my childI agree to my child appearing in club photographs on the newsletter or websiteI agree to club staff supporting my child to administer sunscreenNone of the above
Payment Information
All payments will show on your ParentPay account. This includes the one off registration fee £25 ( New Applicants Only) late fees and any extra sessions. www.parentpay.com
Will you use any Childcare Vouchers?*

YesNo
Name of voucher *
Parent/Carers Signature*
Date*

DayMonthYear
Date
Should be Empty:

Gledowls Registration Form

Emergency Contacts

Payment Information