C3 Kids Allergy Update
Parent/Guardian's Details
Name
*
First Name
Last Name
Email
*
example@example.com
Mobile Number
*
Format: 0000000000.
Name of Child
*
First Name
Last Name
Date of Birth
*
/
Day
/
Month
Year
Date Picker Icon
Is your child anaphylactic?
*
Yes
No
Please upload an Anaphylaxis Mangement Plan from your GP.
*
Browse Files
Cancel
of
Does your child have any allergies/dietary requirements?
*
Yes
No
Please list any allergies/dietary requirements
*
Are there any other medial/special needs or requirements the Team should be made aware of?
What grade is your child in?
*
Not in school yet
K-2
3-6
Do you give your child 'Can Go' permission to leave C3 Kids on their own at the conclusion of the program each week?
*
Yes
No
Do you give your child 'Sibling Pick Up' permission to leave C3 Kids with a sibling in Grades 3-6 at the conclusion of the program each week?
*
Yes
No
Not Applicable
Submit
Should be Empty: