Registration form – The Little Puddings

Name of Parent/Carer 1 *

First

Last

Mobile Number 1 *

Email 1 *

Name of Parent/Carer 2 *

First

Last

Mobile Number 2 *

Email 2 *

Name of child *

First

Last

Age

School Year (e.g. Year 1 Ducklings)

Food Allergies *

Reaction to food: *

Has your child been diagnosed with anaphylaxis *

Yes
No

Does your child carry an Epipen *

Yes
No

Food Intolerance - Specific food intolerant to

Other dietary concerns, cultural food restrictions

Special needs

I give The Little Puddings permission to take photo/video of my child. *

Yes
No

I give The Little Puddings full rights to use the photos/videos of my child for publicity. This might include (but is not limited to), the right to use them in their printed and online publicity and social media. *

Yes
No

Any other notes