Tiny Toms Registration Form - Confidential • TOMS Anglican Churches

Registration Form

DETAILS OF CHILD

Last Name *

Date of Birth *

Will start school in? *

Tip: (eg. 2021)

First Name *

Gender *

Please provide any relevant health information (eg. Allergy, Disability, Restricted activities, Behavioural issues)

DETAILS OF PARENT / CARER

Parent/Carer Name *

Street Address

Street Address Line 2

Suburb

State

Postcode

Contact email (or Parent/Guardian email) *

Preferred Contact Method *

Parent/Carer Emergency Contact Person - Name *

Parent/Carer Emergency Contact - Relationship to Parent *

Parent/Carer Emergency Contact - Relationship to Child *

Parent/Carer Emergency Contact - Phone Number *

Parent/Carer Relationship to Child *

Parent/Carer Contact Number *

During the activities of Tiny Toms photos/video may be taken. I give permission for photos/footage of this child to be used when advertising the group *