Child's Name
*
Address
Please use up to two lines.
Date of Birth
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
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14
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31
Day
Please select a month
January
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Month
Please select a year
2023
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Year
School
*
Please Select
HAPPY LITTLE PEOPLE
ANTONINE
KNIGHTSWOOD
ST CLARE'S
ST NINIANS
First Contact Person - Name, Relationship to Child, Mobile No, Employer & Works Telephone No
Please use only two lines.
Second Contact Person - Name, Relationship to Child/Family & Mobile Number
Please use only two lines.
Main Email Address
*
Additional Needs / Support
*
Yes
No
Details
Allergies
*
Yes
No
List Allergies
Medication
Pickup Notes
Picture Consent
*
Yes
No
Sunscreen Consent to supplying ours
*
Yes
No
Child's Likes
Child's Dislikes
Doctors Name
*
Surgery Telephone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Surgery Address
*
Notes
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Should be Empty: