Participant Enrolment Form 2023/2024

Lion Hearts Play and Learn - Come n Try Day

@Aberfoyle Community Centre, 1 Jessica Street, Aberfoyle Park. 9:30am to 12:30pm
Child's Name

First NameLast Name
Gender
Date of Birth

DayMonthYear
Primary Contact's Name

First NameLast Name
Relationship to child
eg. Mother, Father, Grandparent
Mobile Phone
Format: 0400000000.
E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityState

Postcode
Does your child have any ongoing medical conditions?
(diabetes, asthma, epilepsy, cancer etc)
Does your child have any allergies?
(food, medicine, insects, etc)
Does your child have any special dietary requirements?
Does your child have any behavioral needs and/or concerns?
Is your child toilet trained?
Lion Hearts Learning sometimes use images, videos and other marketing materials to promote what we do through different media forms including on social media. Do you consent for these to be published?
I acknowledge that I have read and understand all the information provided about the applicable program/activity and agree that staff and volunteers shall be indemnified and kept indemnified from any injury, loss or damage whether to property or person whilst the young person is participating in the program of activity.
I understand that this consent will remain valid for 24 months from date of signature (unless withdrawn by you prior).
I understand that my personal details will be added to the Lion Hearts Learning database - this is stored in a confidential place and will not be provided to any other organisation without your written consent.
I agree for my details, including email, to be included in a mailing list for future promotion of Lion Hearts Learning Activities.
By signing and submitting this enrolment form, you are confirming that the information provided by you is true and correct.
Parent/Guardian Signature

First NameLast Name
Today's Date

DayMonthYear
Date
Signature
Should be Empty:

Lion Hearts Play and Learn - Come n Try Day