CD Kids Workshop Registration and Consent Form

CD Kids Workshop Registration and Consent Form

To secure participation in this program we require you to complete the below registration and consent form.
Child's Full Name

First NameLast Name
Date of Birth
Allergies
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Funding Details
NDIS Number
Funding Type
If Plan Managed please provide the Plan Management details. Including: Service name, contact number and invoicing email
Terms Of Service and Privacy Policy
Please Refer to the website for Terms Of Service and Privacy Policy details.
Consent
I affirm to be the legal guardian of the above listed child and give consent for this child to participate in CD Kids at Lemon Drops Kids Therapy. I agree to the above terms and policies associated with the child's participation in this program.
Details Of Legal Guardian
Name

First NameLast Name
Relationship To Child
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
I have read, understand and agree to the Privacy Policy and terms of service as per Lemon Drops Website
I give consent for this child to participate in this CD Kids Group Workshop
Legal Guardian Signature
Date

DayMonthYear
Date
THANK YOU

We appreciate your time and we look forward to your child's participation in CD Kids.If you wish to discuss anything further please feel free to contact us on 0481 304 975 or admin@lemondropskidstherapy.com.au
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Funding Details