So Love Krugersdorp's "Take a child to work" Project (Learner Application)

So Love Krugersdorp's "Take a Child to work" Project.

Learner Application
Parents/Gaurdian Info:*

First NameLast Name
Mobile Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Child info:*

First NameLast Name
ID Number*
Mobile Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Grade Currently in*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AgricultureManufacturingMinistryEducationHairdresserAttorneysElectricianPlumberConstructionFilm MakingTourismVeterinarianMedical Dr.Equine / HorsesTown PlannerLifestyle PhotographerAccountantMarketingEntrepreneurAdminProject ManagerEvent PlannerWedding PlannerGraphic DesignerEducationSales / RetailSafetyBeauty SalonChefLawGas InstallationsScientificFloristDay CareWelfareSocial WorkerFuneral DirectorDog TrainingOptometristPhysiotherapistOther
If "Other" please specify:
Agree
Although every necessary precaution will be taken to prevent accidents, neither So Love Krugersdorp or any Business/Business Owner participating in this program, employees, any agents, guests nor other persons-associated with So Love Krugersdorp or the Business/Business Owner participating in the program will be held responsible for any claims regarding a person arising from an accident which may occur whilst the person is on the premises or at any outing by or behalf of or any of the said persons. This indemnity shall in addition be deemed operative as against any third person suffering damage consequent upon such injury, damage or death. By choosing agree you agree with all of the above*

Agree
Should be Empty:

So Love Krugersdorp's "Take a Child to work" Project.