Registration Page 1 of 3CLUB NAME*LOCATION, DATE & TIMEChild Name *Address*Date of Birth & School YearGenderMaleFemaleParent \ Carer Name*Parent Carer Telephone*Emergency Contact NumberParent \ Carer EMail Address*PreviousNextPage 2 of 3EMERGENCY CONTACT INFORMATIONEmergency Alternative Contact NameRelationship to ChildContact NumberMobile NumberAre there any activities that your child can’t participate in?PreviousNextPage 3 of 3MEDICAL INFORMATIONAny specific medical conditions requiring medical treatment?Any specific medical condition or disability?Any allergies?I give my consent that if an emergency medical situation arises, Actifti may act as loco parentis.If the need arises for administration of first aid and/or other medical treatment which in the opinion of a qualified medical practitioner may be necessary. I also understand that in such circumstances that all reasonable steps are made.* I acceptCantaiad llun/Photo permission(Facebook/Twitter/Instagram a Marchnata/Marketing)* I accept Please enter the security code: Security Code (lowercase letters): PreviousNextSubmit Submit
