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 back room of the library.
Name *
Your answer
Surname *
Your answer
Age *
Your answer
What school does your child attend?
Your answer
Please tick to confirm
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 area 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 yes above, please provide information on the condition and procedures Code club staff need to
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 about 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 number *
Your answer
Parent/Guardian Contact Email Address *
Your answer
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