Registration Form

Part One- General Information

Childs Name

Birthdate

Name of Parent/ Guardian

Address

Email Address

This address will receive a confirmation email

Phone

Are there any special dietary needs which we should be aware of (e.g food allergies)

Adult Emergency Contact Name

Emergency Contact Number

How did you hear about Totally Tots?

Friend Family Social Media Other

I give my permission for my child's image to be printed and/ or posted on a website or social network page associated with PSEBC.

Yes No

I understand that by submitting this form I give permission to PSEBC to store the information herein in compliance with current data protection laws and understand this will not be shared. I agree to receiving occasional communication from a Totally Tots team member relating to church activities or in case of an emergency.

Description

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Registration Form

Description

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