Homework Club Registration Question Title * 1. Child's Name and date of birth Question Title * 2. School attended and year at school Question Title * 3. Parent/Guardian's name and contact number Question Title * 4. Address Question Title * 5. Is anyone legally restricted from access to this child? Yes No Question Title * 6. If yes, please give details. Question Title * 7. Does this child have any special needs? Yes No Question Title * 8. If yes, please give details. Question Title * 9. Name and number of second contact (in the even that the first contact cannot be reached) Question Title * 10. I give permission for my child's photo to be used for promotional purposes. Yes No Done