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After-School Sensory Class Registration Form
Child's first name
Date of birth
Child's Last name
Gender
Parent/Guardian 1 Name
Address
Phone
Email
Parent/Guardian 2 Name
Address
Phone
Email
Details of General Practitioner
What Days & Times Are You Signing Up For
If your child suffers from any illnesses, disabilities or allergies please list below
Tell me as much information as possibe about your child. The more infomation the better!
Preffered method of payment - Payment is required weekly in advance of the following week!
Do you consent to having your child photographed so we can share memories with you parents and for marketing purposes
Submit
Thanks for submitting!
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