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* 1. Child's Name and date of birth

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* 2. School attended and year at school

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* 3. Parent/Guardian's name and contact number

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* 4. Address

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* 5. Is anyone legally restricted from access to this child?

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* 6. If yes, please give details.

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* 7. Does this child have any special needs?

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* 8. If yes, please give details.

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* 9. Name and number of second contact (in the even that the first contact cannot be reached)

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* 10. I give permission for my child's photo to be used for promotional purposes.

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