Thrive Alive Enrolment

Thrive Alive! Enrolment Form

Name *

First

Last

Age *

Gender *

M F

Address *

Authorised Contact Person *

Contact Number *

Email *

Any medical conditions we need to know about *

If we need to phone a doctor or an ambulance we will do so first and try to contact you a.s.a.p. afterwards.
"By enrolling my child in this program, I hereby authorize The Anglican Parish of Mt Eliza to act on my behalf should my child require medical attention."

Doctor's Name *

Doctor's Address *

Submit