KidzArtz Regsitration 2017

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watch Child's First Name:

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*** ATTENTION ***

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Phone Number :

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Is anyone restricted from seeing your child?:

If so, who?

Are there any allergies, health or other concerns which it may be helpful for us to be aware of?
If so, what are they?

Medicare Number:

Reference Number:

Expiry Date :

Tetanus Booster is up to date:

Last Tetanus Booster (if known):

We take individual photos for use during KidzArtz. Please contact us if you have any concerns about this.

I give my permission for leaders to obtain medical treatment in an emergency.

Date (dd/mm/yyyy):

Please note: In an emergency all attempts will be made to contact you. This permission is sought if, despite our best efforts, we are unable to contact you.

The leadership of each group mentioned above will treat the information contained in this form with confidentiality. This information may be shared with a third party when it concerns the medical health or care of your child. If you wish to access this information or have any queries in the relation to the manner in which we handle your personal information, please do not hesitate to call us.