Summer camp REGISTRATION FORM

REGISTRATION FORM

Courage Together Summer Camp
Child 1*

First NameLast Name
Date of Birth Child 1*

MonthDayYear
Date
Child 2

First NameLast Name
Date of Birth Child 2

MonthDayYear
Date
Child 3

First NameLast Name
Date of Birth Child 3
Parent/Carer Full Name*
Email*
example@example.com
Phone Number*
Address*
Post Code*
Emergency Contact Name*
Emergency Contact*
Do you give permission for your child(ren) to be in our social media*

YesNo
Please detail below If any of your children attending have any medical condition(s) or special needs?*
Do any of your children have any allergies or dietary requirements? please detail
If your child has any allergies or dietary requirements you must provide snacks and lunch suitable for them
Name and Address of GP*
I consent to emergency medical treatment to be given to the children on this form and

I declare that all Information Is true and correct
Signature*

Clear
Date

MonthDayYear
Date
Should be Empty: