Attendee Enrollment Form

 

Please fill out the form below for each attendee.

 

Parent Details

First Name *
 
Last Name *
 
Contact Email Address *
 
Mobile Phone *
 
Home Phone
 
Address
Town/City
 
Post Code/RD
 
 

Emergency Contact Details

First Name *
 
Last Name *
 
Email Address
 
Phone Number *
 
Relationship to Child
 
 

Child Details

First Name *
 
Last Name *
 
Gender *
 
Date of Birth *
 
What is the school this child currently attends?
 
School Year
 
Promotional Material Photo & Video Permission *
Do you consent to this Student appearing on photos or videos while at Ultimate Transformations programmes for use in promotional material for Ultimate Transformations.*
 
Your Child At Home
Are there any adults that are not authorised to be with this child? (Please write N/A if not applicable.)
 

Health Details

Does your child have any known allergies? *
 
Is your child allergic to bee stings? *
 
Does your child have asthma? *
 
Does your child take any medication? *
 
If you answered 'Yes' to any of the above, please provide details:
Does your child have any medical conditions or health problems that we need to be made aware of? *
 

Family Doctor

Medical clinic name *
 
Doctor's name
 
Doctor / Clinic phone number *