Seedlings club registration

Date of club *

Name of child *

Age of child (must be 18 months - 4 years) *

Address *

Parent/guardian's mobile number *

Parent/guardian's email *

Date of child's last tetanus vaccination (vaccination is not mandatory)

Is the child physically fit?

Does the child have medical and/or behavioural conditions or disabilities we should we aware of? *

Details of medical or behavioural conditions

Does the child require a special needs carer to accompany them? *

Carer's name and contact number

Is the child taking medication? *

Details of medication

Is the participant allergic to anything? *

Details of other allergies

Does the child have any specific interests that we may be able to include in the club?

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