Discovery Club Registration Form 2021-2022
Please answer all questions to the best of your ability. Should you have any questions, feel free to reach out to tpenn@bnt.bs, jcartwright@bnt.bs or call us at (242) 393-1317.
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Child's Name (First, Middle & Last) *
Child's Gender *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
DC Level *
Member email: (child's) *OPTIONAL*
School *
Island *
Settlement/ Subdivision *
Name of Parent/ Guardian *
Phone: Parent/Guardian (Home / Cell) *
Parent/ Guardian Email: *
Name of Emergency contact (Other than Parent/Guardian listed above) *
Phone: Emergency Contact (Home / Cell) *
Physician's name *
Physician's Telephone contact *
Select which applies: Medical History *
If your child has a medical history, please specify *
Does your child have health insurance? *
If Yes, what is the company's name? *
If Yes, what is the name of the policy holder? *
If Yes, what is the policy number? *
Payment Option *
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