This year we're going to give you the opportunity to register online if you want to.
Please complete all questions (enter 'N/A' if question doesn't apply) - Thanks
Child's Name:
Child's Date of Birth:
Child's gender:
School child attends (they must currently be school aged to be eligable to attend):
Child's current school year (2012/13):
Are there any friend's you would like to be in the same group (this may not always be possible):
Parent/Guardian's Name:
Address (inc. postcode):
Email address:
Phone number:
Emergency contact:
Emergency contact's phone number:
Any known medical conditions (e.g. asthma, epilepsy, diabetes):
Any known allergies (e.g. nuts, dairy):
I give permission to be contacted about future events:
I give permission for my child’s photo to be taken and used for publicity:
By entering your name and the date below you are agreeing to the following:
Please register my child for ‘space academy’. I confirm that the above details are complete and correct to the best of my knowledge. In the unlikely event of illness or accident I give permission for any necessary medical treatment to be given by the nominated first-aider. In an emergency and if I cannot be contacted, I am willing for my child to receive hospital treatment, including anaesthetic if necessary. I understand that every effort will be made to contact me as soon as possible.
Today's date: