Little Surfers Registration Form
Name of Child
*
First Name
Last Name
Child's Date of Birth
Name of Parent/Guardian
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
example@example.com
Do you give permission for your child to be photographed during Little Surfers activities, and for his/her photograph to be used on noticeboards in the parish centre, church or in the parish magazine, parish website, the diocesan website, diocesan magazine and the Little Surfers Facebook and Instagram pages.
I do give permission
I do not give permission
Please give details of any medical conditions, allergies or medicines:
Signed by Parent/Guardian
Date
Continue
Continue
Should be Empty: