Wellington July School Holiday Registration Form

Childs Date of Birth

MonthDayYear
Date
Emergency Contact Name
Emergency Contact Phone Number
Emergency Contact Relationship to Child
What special interests does the child have?
Has your child had a formal diagnosis? If Yes, please provide more info.
Describe your child's communication capability, i.e. non verbal, verbal with limited vocabulary, good communication
Any known triggers to be aware of?
Toileting capability

Other

Does your child have any allergies? Please list all allergies and type of reaction
Does your child need to take any medication during the day? If yes, provide additional details.
Are you comfortable with your child eating in a shared food situation?

Other
Are you comfortable with your child's picture being shared on social media (with face covered)?

Other