Cub details

Medications handed into Supervisor during programme

Yes
No

Can we apply sunblock to your cub?

Yes
No

Cub's Doctor

Name

Phone Number

Start date

Attendance:

Regular
Casual

Days attending

Parents/Caregivers details

Name

Day phone

Mobile phone

E-mail

Address

Name

Day phone

Mobile phone

E-mail

Address

Emergency contact

Name Phone

Name Phone

Persons other than parents authorised to collect your cub

Name

Name

Is there anything els we should know about?

Can we photograph your cub?

Yes
No

I understand the conditions of Pride Lands and agree to abide by the terms.

I accept the conditions required

Survey (optional)

How did you hear about Pride Lands?

Is there anything we could improve?

This information is private and confidential. Thank you for your support.