Child's Name

Parent's / Guardian's Name

Address

Email Address

Home Phone

Mobile Number

Child's Date of Birth

Emergency Contact Details 1 - Name

Emergency Contact Details 1 - Phone

Emergency Contact Details 2 - Name

Emergency Contact Details 2 - Phone

Does your child have any health problems or does he/she take any medication?

Does your child have any allergies?

Is there any other information we need to know?

I agree that my child may be photographed or videoed for media purposes

I also agree that The Academy takes no responsibility for the safety of my child, once he/she leaves the building

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