Registration / Medical Form
Dear parent/carer,

This form is designed to ensure we can always help keep your child safe. Please fill this out to the best of your knowledge. All information is confidential.

Thank you in advance.
Email address *
Above The Water
Child's name: *
Your answer
Date of birth: *
MM
/
DD
/
YYYY
Address: *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Home Number *
Your answer
Emergency Contact Mobile Number *
Your answer
Emergency Contact Email Address *
Your answer
Preferred method of contact *
Day of lesson: *
Time of lesson: *
Time
:
Type of lesson: *
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