Floating Classroom Afterschool Nature Club (Stone Wharf) Registration Form

Afterschool Nature Club (Stone Wharf) Registration Form
Child's Full Legal Name*

First NameLast Name
Child's Preferred Name (if different)
Child's Date of Birth*

DayMonthYear
Date
Name of child's school*
School's Postcode*
Type of school*
Parent / Guardian / Carer's Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Child's Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Please provide a name and phone number for an additional emergency contact (in case we can't reach you)*
Does your child have any access or learning needs?*
If yes, please provide details so that we can ensure that we are able to provide appropriate support.
Does your child have any dietary requirements or allergies?*
YesNoPrefer not to say
I grant The Floating Classroom and Westminster Foundation full rights to use the images resulting from the photography of my child, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the charity’s aims.I do not grant permission to use images resulting from the photography of my child.
How did you hear about this club?*
YesNo
Should be Empty: