Registration Form Parent Name * First Name Last Name Phone * (###) ### #### Email * Town where you live * Child 1 Child Name * First Name Last Name Date of birth * MM DD YYYY Any allergies or disabilities? * 2nd sibling Name First Name Last Name Date of birth MM DD YYYY Any allergies or disabilities? 3rd sibling For Young Learners each child must be accompanied by an adult Name First Name Last Name Date of birth MM DD YYYY Any allergies or disabilities? Do you authorise permission to take and share photos of your child/ren on social media to help me promote my programme? * Yes, no problem! Yes, but not the face please No, Thank you Monthly Newsletter Yes, I would like to receive news, upcoming events and insights T&C * I agree to the Terms & Conditions Yes Thank you! We will be in touch with you soon.
