Calvary Youth Boys Fire Night • Calvary Family Church

First Name *

Last Name *

Mobile Number *

Tip: If your child has their own mobile please provide this, as it assists us in contacting them in the event of an emergency.

Dietary Requirements

Does your child have any known allergies? If so, please provide Epipen. *

Yes

No

Does your child have Asthma? If so, please provide Asthma Plan. *

Yes

No

Permission for my child to receive medical treatment by a first aid officer. *

Yes

No

Permission for my child to be given paracetamol / ibroprofen? *

Yes

No

Permission for my child's photographs for social media? *

Yes

No

Emergency Contact (Parent/Guardian) *

Emergency Contact Phone *

Comments or Questions

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