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Life Kidz Information Sheet
Personal Information
Parent/Caregiver Contact details
Parent/Caregiver
*
person completing this form
First name
Last name
Home Address
*
Address line 1
Address line 2
Address line 3
Address line 4
Town/Suburb
City
Postcode/Zip
Cell phone
Email address
Home phone
Please complete this form with your children's details, add another enables you to add another child's details to be completed on the same form.
Child's name
*
First name
Last name
Gender
*
Female
Male
Date of Birth
*
School/Preschool
*
School Year
0
1
2
3
4
5
6
7
8
9
10
11
12
13
Medical Conditions
Asthma
Chronic Nose Bleeds
Deafness
Diabetes
Dizzy Spells
Epilepsy
Fits of any Type
Hay Fever
Migraine
Travel Sickness
Allergies
*
if there is no known allergies, please put NONE. If this changes please update this information asap
Permission for use of photos
Please select yes if you give permission for use of photos on social media or our website
No
Yes
Is there anything else we need to be aware of
+ Add another
- Remove
Date
Please check the highlighted fields
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