Dynamites Music Registration Form

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Dynamites Music is a music playgroup run by St Marks Anglican Church, Freshwater.
Please also forward this form to the parent if you are the nanny, grandparent or other carer.

By filling out this form you agree:

I hereby release and discharge all associated with Dynamites Music from all responsibility and liability for any accident or sickness which may befall the child/children specified below, or any damage to his or her property while attending Dynamites Music.

Name of child 1 *

What allergies does child 1 have?

Name of child 2

What allergies does child 2 have?

Name of child 3

What allergies does child 3 have?

Any special needs or other info which will help us give your child the best possible care

Your name (all adults accompanying the child to Dynamites Music) *

What allergies do you have?

Mobile number *

Email address *

Are you the child's: *

If you are not the parent, please provide the parent's name.

Please also text the form to the parent to fill in.

Parent's mobile

Parent's email address

Do you agree *

I give consent for photos of us to be used for advertising purposes online

I give consent for photos of us to be used for advertising purposes in print/email/whatsapp

Other:

Required

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