REGISTRATION

1a.)First Child's Name:Surname:
Date of birth:Age:Class/Year:
Medical condition:
School:


  b.)Second Child's Name:Surname:
Date of birth:Age:Class/Year:
Medical condition:
School:


  c.)Third Child's Name:Surname:
Date of birth:Age:Class/Year:
Medical condition:
School:


2a.)  Payment Details
        Details required for tax rebate purposes

       Name of taxable parent/guardian:ID Card:


  b.)  Tax Rebate
        You agree that the above information is correct and can be sent to the Inland Revenue Department for tax rebate purposes.
yesno


3.)  Emergency contact details of parent/guardian
Mother's Name:Mother's Mobile:
Father's Name:Father's Mobile:
Postal Address:Email:


4.)   Please tick as required:
early drop offlate pick upno pictures*

*Creative Energy Kids' Club may from time to time take photos of the children during the summer school. As required by the Data Protection Act, should you not wish to have your children appearing in such photos, kindly tick this box.


5.)  Friends
      Please write down one/two friends of your child who will be attending the club:

We will do our utmost to place friends together so long as this is possible.