Kids club registration form
When? Mondays 17:00-18:30 in May and June (starting 13th May and not running on the June Bank Holiday)
Where: Hansfield Educate Together NS, Barnwell Rd, Hansfield, D15
Contact us at dublinwestyouth@gmail.com for more details!

If you have multiple children who might attend you can just fill out one form. Please specify which child for things like allergies and medical conditions.

Your Name *
Your answer
Childs name/s *
Your answer
What class are your children in? *
Please answer this for each child
Your answer
Emergency Contact 1 Name *
Your answer
Emergency Contact 1 Number *
Your answer
Emergency Contact 2 Name *
Your answer
Emergency Contact 2 Number *
Your answer
Dietary restrictions or allergies
Please specify which child has the dietary restriction (e.g. vegetarian, gluten-free) or allergy (e.g. nuts, strawberries)
Your answer
Medical conditions or other special needs/requirements that would be helpful for leaders to know.
Please specify which child has the medical condition or extra needs.
Your answer
During the kids club photographs may be taken, please specify any/all permission you give for these to be used *
Required
I understand that I (or another responsible adult) will have to sign my child in and out on Monday nights. *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.