y6 registration form WEDS 6.30-8.30pm

y6 group wed 6.30-8.30 , new members from 10/11/21

please take care to fill all boxes accurately.

Thanks

Any questions call Donna on 07809085029 or Kath on 07866980974

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* 1. name of young person and date of birth

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* 2. gender ?
male/ female/ non binary / other?

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* 3. any medical info? allergies? medication ( if so what and what dosage?)diabetes? asthma? epilepsy? learning difficulties? special needs? please detail below.

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* 4. can we use photos on publicity and social media?

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* 5. name of parent and contact number

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* 6. name of GP

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* 7. Which school and year are they in?

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* 8. emergency contact details -
Name of Contact:
Relationship to Young person:
Telephone Number:
Mobile Telephone Number:
Email address:

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* 9. How would you describe your child's ethnicity?

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* 10. I would like to be kept updated by text / email