Space Academy Child Registration

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Space Academy Child Registration Form

* Indicates required field

Child's Name *

First

Last

Parent/Guardian's Name *

First

Last

Gender *

Male Female

Date of Birth *

Child's Address *

Line 1

Line 2

City

State

Zip Code

Country

GP's Name *

GP's Telephone Number *

Any known allergies or medical conditions *

My child will be attending Space Academy on *

Monday 6th August 2018 Tuesday 7th August 2018 Wednesday 8th August 2018 Thursday 9th August 2018 Friday 10th August 2018

Paren't/Guardian's Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

To keep you updated on other Wave Kids events and activites. Your details won't be shared with anyone else.

Contact Number *

Emergency Contact Number *

I give permission for my child's details to be entered onto the Wave Kids database (information will be kept confidential and won't be shared with third parties) *

Yes No

I give permission for my child's picture to be taken during the club (the photos will be used for Wave Kids publicity only, such as on the website and newsletters) *

Yes No

I give permission for my child/ward (named above) to attend the Space Academy holiday club and understand that if they fail to adhere to the clubs code of conduct, I may be called to collect my child early. *

Yes

Thank you for completing this form. All information will be stored securley and treated in accordance with the Data Protection Act 1998.

Submit

Who We Are
What We Do
- Notelets
- Stars
- Tetra
- Schools
- Sundays
Meet the Team
Team Blogs
Get Involved
Events
- Space Academy
Get in Touch