Wees Lig Kleuter Kampus – Wees Lig Kinderkampus

Child's Information

Child's Name

First

Last

Date of Birth

Class Attendance Options

2x per week
3 x per week
5 x per week

Child's Medical Information

Does your child have any medical condition we need to be aware of

Allergies:

Food
Medication
Other Allergies
None

Food

Please list treatment to be taken in case of reaction.

Medication

Please list treatment to be taken in case of reaction.

Other Allergies

Please list treatment to be taken in case of reaction.

Do you have a Medical Aid?

Yes, Medical Aid
No, Private

Medical Aid Name

Main Member's Name

Dependent No.

Please upload a photo of your medical aid card

Click or drag files to this area to upload. You can upload up to 2 files.

Please upload a photo of your medical aid card Front and back of card is required

Emergency Contacts:

Attendance a aware

Name

First

Last

Relationship to child

Phone

Please read the terms below

I Agree

I have read and agree to all the terms stated below.
I, the parent / guardian, hereby give consent that he / she may participate in learning activities at Wees Lig Kleuter Kampus.
If my child may need medical care / surgical treatment and Wees Lig Kleuter Kampus have made reasonable unsuccessful efforts to get hold of me or the designated contact person (whose name and details will appear in the entry form) the trainer may give consent on my behalf for medical treatment / surgical intervention.
I declare that as far as I know my child is physically able to participate in any activities and normal operations at Wees Lig Kleuter Kampus, and that my child is in good health. I also confirm that I have notified Wees Lig Kleuter Kampus of all relevant facts and deficiencies regarding my child's physical abilities and health.
I accept that I will be responsible for payment of expenses, medical bills and / or hospital bills, if applicable, in the event of injury to my child. I indemnify and hold Wees Lig Kleuter Kampus harmless against any damages, claims or liability that may result from damage to or loss of property, injury, illness or death affecting me or my child, and related to my child's participation in any activities (including the transportation of my child) of Wees Lig Kleuter Kampus.

All information is truthful and up to date

I Agree

I hereby acknowledge that I have provided all relevant medical information. I will agree to keep Wees Lig Kleuter Kampus up to date with any medical changes.

Parent's / Guardian's Information

Parent's / Guardian's Name

First

Last

Parent's / Guardian's ID Number

Parent's / Guardian's Email

Parent's / Guardian's Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent's / Guardian's Employer

Employer Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Starting Date

Indemnity Form for Parents / Guardians

I Agree

I, the parent / guardian, hereby give consent that he / she may participate in training activities at Wees Lig Kleuter Kampus. I realise that although Wees Lig Kleuter Kampus undertake to take reasonable care to ensure my child's safety and well-being during practice hours and during competitions and performances, Wees Lig Kleuter Kampus can not guarantee the safety and wellbeing of my child at all times. If my child may need medical care / surgical treatment and Wees Lig Kleuter Kampus have made reasonable unsuccessful efforts to get hold of me or the designated contact person (whose name and details will appear in the entry form) the trainer may give consent on my behalf for medical treatment / surgical intervention. I declare that as far as I know my child is physically able to participate in any activities and normal operations at Wees Lig Kleuter Kampus, and that my child is in good health. I also confirm that I have notified Wees Lig Kleuter Kampus of all relevant facts and deficiencies regarding my child's physical abilities and health. I accept that I will be responsible for payment of expenses, medical bills and / or hospital bills, if applicable, in the event of injury to my child. I indemnify and hold Wees Lig Kleuter Kampus harmless against any damages, claims or liability that may result from damage to or loss of property, injury, illness or death affecting me or my child, and related to my child's participation in any activities (including the transportation of my child) of Wees Lig Kleuter Kampus.