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
Get Involved
Get in Touch