Halloween Registration Form

Step 1 of 6

Child Information

Step 2 of 6

Family Information

Mother Information

Father Information

Step 3 of 6

Address of Residency

Yes     No

Step 4 of 6

Emergency Contact Information & Authorized pick up (if other than mum & dad)

First Person

Second Person

Step 5 of 6

Medical Details

Allergies:

Yes No

Respiratory difficulties:

Yes No

Physical disability:

Yes No

Vision impairment:

Yes No

Hearing impairment:

Yes No

Other health concerns:

Yes No

Step 6 of 6

Non-prescription Medicine Administration

I hereby authorize StepUp Academy, to administer the following medication/products according to manufactures/physician written instructions should it be required. I will not hold StepUp Academy liable for any allergic reactions, or other symptoms, when the medication/products are used.

Antiseptic Lotion/Liquid/Wipe:

Yes No

Plasters:

Yes No

Insect Bite Cream/Lotion:

Yes No

First Aid Ointment:

Yes No

Calpol/Neurofen/Panadol:

Yes No

Ice:

Yes No
I agree to fulfil the obligations set forth to StepUp Academy and will ensure all school terms in which I/my child attends are accounted for and terms & conditions followed