Wildlings club registration

Date of club *

Name(s) of child(ren)

Age(s) of child(ren) (must be 5-11 years) *

Address *

Parent/guardian's mobile number *

Parent/guardian's email *

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

Are the children physically fit?

Do any of the children have medical and/or behavioural conditions or disabilities we should we aware of? *

Are any of the children taking medication? *

Details of medication

Are any of the children allergic to anything? *

Details of allergies

Should your child(ren) require first aid, do you give permission for it to be administered? (Permission form required) *

Details of medical or behavioural conditions

Do any of the children require a special needs carer to accompany them? *

Carer's name and contact number

Do any of the children have any specific interests that we may be able to include in the club?

Name and contact number of the person dropping off the child(ren) *

Name and contact number of the person collecting the child(ren) *

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