Westland District Library Code Club Registration Form
Please register for Code Club and we will add you to our waiting list . Sessions are held in the room at the back of the library.

Keri *
Your answer
Surname *
Your answer
Age *
Your answer
Please tick to confirm *
Required
Permission for my child to have his/her photo taken for use in related brochures, workbook, website, blogs or on Facebook. *
In order to ensure the safety of your child while in our care please indicate any areas of concern or health issues that staff at code club should be aware of . If yes - please provide details in the following section below
Health issues - Details.If you answered yes above, please provide information on the condition and procedures code club staff need to be aware of.
Your answer
*
Are there any other issues relating to your child’s safety that we need to know about? (e.g. custody arrangements, etc.) If yes please provide details below *
Other issues - Details. If you answered Yes above-please provide information code club staff need to be aware of.
Your answer
Emergency Contact - Name *
Your answer
Emergency Contact - Phone Number *
Your answer
2nd Emergency Contact - Name *
Your answer
2nd Emergency Contact - Phone Number *
Your answer
Please tick to confirm *
Name of Parent/Guardian completing this form *
Your answer
Parent Guardian/Contact Phone *
Your answer
Parent/Guardian Contact Email *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms