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APPLICATION FORM – CHILD
First name of child
Last name of child
Child's gender
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Home address
Email address of parent/guardian
Phone number of parent/guardian
Emergency backup phone number
Child's date of birth
School year
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Child's school
Which location are you applying for?
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As far as you are aware, does your child have any allergies?
Yes
No
Child's allergies
Is your child taking any regular medication?
Yes
No
Medication
Please give us any information regarding your child’s health, behaviour, communication, mobility, schooling and any other issues which help us meet their needs whilst attending The Habbit Factory. If necessary, please supply a care plan.
Do you grant The Habbit Factory the absolute right to use the images resulting from photo / film shoots. This includes any reproductions or adaptations of the images for all general publicity purposes?
Yes
No
First name of child's parent/guardian/carer
Last name of child's parent/guardian/carer
Next of Kin's name / how they wish to be referred to
Next of Kin's relationship to child
Application approved by child’s parent/guardian/carer
I have read, understood and accept the Terms
(Terms)
Your Signature
Clear
Date of application
Donation type
£0
£10
£15
£20
Other
SUBMIT APPLICATION
Thank you for applying! We will be in touch.
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