Kiddo Registration Child's Name * First Name Last Name Child's Date of Birth * MM DD YYYY Parent / Caregiver Name * First Name Last Name Email * Phone * (In case of emergency primary number) (###) ### #### Alternative Phone * (if we can't get through to your primary in case of emergency) (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Medical / allergies Does your child have any allergies or medical conditions I need to be aware of? Safeguarding Are there any other issues around your child's safeguarding you'd like me to be aware of? Media * Do I have permission to photograph or film your child for the purposes of promoting these sessions? Yes Conditional yes No Promo How'd you hear about these sessions? (Super helpful for my marketing efforts, if you don't mind... ) Keeping In Contact * Here are all the ways I can notify you about my work. Please tick all that apply (you can unsubscribe any time...) 'Impro Yo' whatsapp group Educational workshop updates Lunar Meow (my 'everything' newsletter) Diolch yn fawr! Thank you for your purchase! I’ll be in contact to confirm all details soon.
