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Thrive Alive! Enrolment Form
*
Indicates required field
Name
*
First
Last
Age
*
5
6
7
8
9
10
11
12
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
*
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 Address
*
Submit
