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Pittwater Anglican Church
Registration Page
Please complete details for children who attend mainly music:
*
Indicates required field
Child 1 Name
*
First
Last
DOB
*
Enter as DD/MM/YY
Allergies/Intolerances:
*
Gluten/Wheat
Dairy/Milk
Nuts
*
Eggs
Fish
Other
Detail "other"
*
Child 2 Name:
*
First
Last
[object Object]
DOB
*
Enter as DD/MM/YY
Allergies/Intolerances:
*
Gluten/Wheat
Dairy/Lactose
Nuts
*
Eggs
Fish
Other
Detail "other"
*
Child 3 Name:
*
First
Last
DOB
*
Enter as DD/MM/YY
Allergies/Intolerances:
*
Gluten/Wheat
Dairy/Lactose
Nuts
Choose Any
*
Eggs
Fish
Other
Detail "other"
*
Details about your Family (complete where applicable):
Parent Name
*
First
Last
Birthday
*
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Birthday
*
Month
January
February
March
April
May
June
July
August
September
October
November
December
Family Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Email
*
For Caregivers
(Please complete where applicable):
Caregiver Name
*
First
Last
Caregiver Address
*
Line 1
Line 2
City
State
Zip Code
Country
Relationship to child(ren):
*
...
Grandparent
Friend
Aunt/Uncle
Other
Caregiver Phone Number
*
Caregiver Email
*
How did you find out about mainly music?
Choose Any
*
Friend/Relative
Website
Church
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