REGISTER FORM

Reference

Childs Name

Childs Age

Child's Date of Birth

Parent/Carers Name (s)

Parent/Carers Mobile Number (s)

Parent/Carers Email Address (es)

Parent/Carer (s) Home Phone

Location

Seaford
Brighton
Lewes

Child's Initials & Surname

Parent/Carer (s) Work Phone

Phone Number

Home Address

used Please Number

Does your child have any allergies or medical conditions? Please detail below. *

Does your child have any dietary requirements? Please detail below.

Do you give permission for your child's photo to be used in any publicity e.g.,social media for Develop Outdoors, local papers, including having their photoor video taken?

Emergency Contact Details (1)

We need to be able to contact you, or a person nominated by you, in case ofemergency. Please provide details of two people for this purpose (thesepeople will also be allowed to collect your child).

Emergency Contact Details (2)

We need to be able to contact you, or a person nominated by you, in case of emergency. Please provide details of two people for this purpose (these people will also be allowed to collect your child).