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Upton Earlies and Upton Lates - Registration Form and Agreement
Registration Form and Agreement • June 4th, 2018

Child’s details Name: Class: Date of birth: Home address: Child’s doctor: Telephone:Surgery Address: I consent to my child receiving medical treatment in the event of an emergency YES / NO Parent/Carer details Name: Address: Name: Address: Relationship: Home telephone: Mobile(s):Work telephone(s): Relationship: Home telephone: Mobile(s):Work telephone(s): Person/s authorised to collect children in an emergency Name: Name: Address: Address: Relationship: Relationship: Contact number: Contact number:

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