Vibrant Communities October Holiday Registration

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1. Parents/ Guardians Details

1. Parent/Guardian Details *

Forename	*
Surname	*
Address 1	*
Address 2	*
Address 3	*
Post Code	*
Telephone Number	*
Mobile Number	*
Email Address	*

2. Do you give permission for photographs to be taken of your young person and used in promotional material by East Ayrshire Council? *

Yes, I give permission
No, I do not give permission

3. Young Person *

Name	*
D.O.B (DD/MM/YEAR)	*
Dietary requirements? (If yes detail)	*
Any medical conditions? (If yes detail)	*
School	*

4. Would you like to register anymore young people? *

Yes

No