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Footprints Registration Form
Please complete the following information to register your child with Footprints. If you are registering multiple children, you will need to fill out this form twice.
Email address *
Main contact phone number: *
Your answer
Child's Name *
Your answer
Child's Age and D.O.B *
Your answer
I am registering my child, for the following class(es) *
Required
Please confirm the following *
I will be collecting my child each week, after class, from the YMCA main lobby entrance inside (please inform us via phone, before class, on 07544249411 the details of who is due to collect your child)
Required
Please confirm the following *
I give permission for my child(ren) to be photographed/filmed for the purpose of promoting Footprints publicly on the Footprints website and on social media pages
Required
Please confirm the following
I give permission for my child to participate in public performances
Please use the space provided below, to inform us of any medical conditions, allergies or allergens:
Your answer
Please use the space below, to inform us of any special educational needs or emotional, social or physical support that may be required for your child:
Your answer
Your Details
Emergency Contact Name *
Your answer
Emergency Contact Relation to Child *
Your answer
Emergency Contact Number *
Your answer
Alternative Emergency Contact Number, Name and Relationship to Child
Your answer
Signed (Type your name) *
Your answer
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