Vibrant Communities Easter Holiday Registration 0-12 year old

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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