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Parent Name *

Contact Number *

Child's Name

Child's Date of Birth

School

Year Group

Date of Club

Time of Club

Emergency Contact Number 1

Emergency Contact 1 Name

Relationship to Child

Emergency Contact Number 2

Medical Info/Allergies

At the end of this session my child will be

Collected

Walking Home

I give consent for my data to be shared with third parties if necessary.

I give consent for photos to be taken

Preferred Method of Communication

Special Requests/Comments

Book