OTGi Application Form 10-16-years old
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1. Full Name of Child *

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*
 

2. Full Name of Parent/Guardian *

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*
 

3. Your Relationship to the Child *

 

4. Child's Date of Birth *

   DD/MM/YYYY 
 
 

5. Child's Age (must be 10-16 years old to register) *

 

6. Child's Sex *

 

7. Your Address *

 

8. Contact Number(s) *

*
 

9. Your Email Address *

 

10. When did your child have their last eye examination? *

 

11. What is your child's spectacle prescription? (from the last opticians eye test, leave blank if unsure) NOTE: If using a smart phone, turn screen landscape

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Right Eye
Left Eye
 

12. Please attach a photo of the spectacle prescription (from the last opticians eye test, leave blank if not possible)


 

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13. Does your child wear glasses or contact lenses at present? *