VI Child Registration
Email address *
Names of guardian(s) *
Guardian(s) relationship to child *
Address *
Address 2
Region *
Postcode *
Landline
Mobile Phone *
How would you like to receive information from Useful Vision? (please tick all that apply) *
Required
Name of visually impaired child *
Date of birth (DD/MM/YY) *
Ethnicity
Gender *
Names and DOB of all siblings (state if also VI)
What is the name of your child's eye condition? *
Is your child registered blind or partially sighted?
Clear selection
Please describe any additional needs for your child
How did you hear about Useful Vision? *
Emergency Contact Details 1 (Name, relationship to child & number) *
Emergency Contact Details 2 (Name, relationship to child & number) *
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