The Witches Are Back

Comments

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Parent / Guardian Name*

First Last

Address*

Street Address Address Line 2 City Postcode

Parent / Guardian Phone*

Parent / Guardian Email*

Additional Parent / Guardian / Contact Name

Additional Parent / Guardian / Contact Phone

Child Name*

First Last

Child Date of Birth

Emergency contact

Parent / Guardian (as entered on the first page)

Emergency Contact Name*

First Last

Emergency Contact Phone*

Child’s Medical Conditions, if any

G.P’s Name*

G.P’s Phone Number*

Who will be collecting the child?

Parent / Guardian (as entered on the first page)

Collecting Person Name*

First Last

Additional adult who can collect the child

First Last

Is there anything else we should know about your child?

Parent / Guardian Signature*

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