Mother-Daughter Tea Club registration form
Please fill out one form per child
Mother's Name *
Your answer
Mother's email *
Your answer
Mother's phone number *
Your answer
Mother's address *
Your answer
Daughter's name *
Your answer
Daughter's date of birth *
MM
/
DD
/
YYYY
Daughter's school *
Your answer
Does your daughter suffer from any medical conditions? If so, please specify details and treatment: *
Your answer
Your contribution: We would be happy to provide an item for afternoon tea on (please select two months): *
Required
We would be happy to lead the activity (craft, games, cooking, drama, etc) on: *
Required
Consent: I, the parent/guardian of the registered participant, approve of this application and in doing so, permit that: *
Yes
No
Rimbrook Study Centre fully licenced drivers to drive my daughters to and from activity locations and as the Rimbrook activity requires it
If in the event of an injury to my daughter, Rimbrook Study Centre staff and voluntary helpers are authorised, by me, to obtain at my expense any medical, ambulance or like services, if deemed necessary or desirable
Any photos or videos taken during the programme may be used in future Rimbrook Study Centre promotional material
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