Customer Registration Form

1. Child's detail

Gender:
BoyGirl


2. Parent's detail


3. Other Parent's detail


4. Alternative caregiver's detail (Optional)


5. Emergency contact's detail


6. Medical Information:

Is your child/ren currently up to date with their age appropriate vaccinations?
YesNo


Does your child/ren have any medical disabilities or special education needs?
YesNo


Does your child /ren have any medical problems or allergies, including food or topical allergies?
YesNo


Is there anything in particular you would like us to take note of for your child's well being?
YesNo