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*
Format: 00000000000.
Address*
Post Code*
Emergency Contact Name*
Emergency Contact*
Format: (000) 000-0000.
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*
Date

MonthDayYear
Date
Should be Empty: