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.

Name
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
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