Name of child/ Имя ребенка:
Date of birth/Дата рождения
Home address/Домашний адрес:
Телефон
E-mail
Хотите получать новостную рассылку? / Do you want to receive newsletters? YES / NO
Does your child have any special needs/additional requirements that this service should be aware of?
Father’s Name/Имя отца
Mother’s name/Имя матери
If parents are not available in an emergency please name two other adults that may be contacted?
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