After School Program Afterschool Program Registration FormChild’s InformationFirst NameLast NameDate of BirthAgeSchool AttendedParent/Guardian InformationFirst NameLast NameRelationship to ChildPhone/MobileEmailHome AddressEmergency Contact (if different from above)First NameLast NamePhone/MobileRelationship to ChildAttendanceTick the days your child will attend Monday Tuesday Wednesday ThursdayMedical & Allergy InformationDoes your child have any medical conditions? Yes NoDoes your child have any allergies (including food, medicine, or environmental)? No known allergies Yes (please specify)Yes (Please provide details of any medication your child requires)Photo/Video ConsentWe sometimes take photos/videos during activities for use in displays, newsletters, and our official website/social media. Please indicate your preference below: Yes, I give permission for my child’s photo/video to be taken and used by Lote Tree Nursery for the purposes stated above. No, I do not give permission for my child’s photo/video to be taken or used.Parent/Guardian Initials:Submit Form
