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OTGi Application Form 8-18-years old
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1. Full Name of Child
Required
- Required.
This question requires an answer
First Name
Surname
*
2. Full Name of Parent/Guardian
Required
- Required.
This question requires an answer
First Name
Surname
*
3. Your Relationship to the Child
Required
- Required.
Mother
Father
Legal Guardian
*
4. Child's Date of Birth
Required
- Required.
*
*
5. Child's Age
(must be 8-18 years old to register)
Required
- Required.
*
6. Child's Sex
Required
- Required.
Male
Female
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7. Your Address
Required
- Required.
*
8. Contact Number(s)
Required
- Required.
This question requires an answer
Main
Home
Alternative
*
9. Your Email Address
Required
- Required.
*
10. When did your child have their last eye examination?
Required
- Required.
Less than 6 months ago
1 year ago
2 years ago
<span style="color: #000080"><strong>2-5 years ago</strong></span>
<span style="color: #000080"><strong>More than 5 years ago</strong></span>
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
Sphere
Cyl
Axis
Near Add
Right Eye
Sphere
Cyl
Axis
Near Add
Left Eye
Sphere
Cyl
Axis
Near Add
12. Please attach a photo of the spectacle prescription
(from the last opticians eye test, leave blank if not possible)
Drag and drop your files here
or click to browse your files
Maximum of 2 files, up to 50 MB each
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13. Does your child wear glasses or contact lenses at present?
Required
- Required.
No
Yes, glasses only
Yes, contact lenses and glasses
