Registration Form
KGV Rock and Water Adventure
Hi there!
We ask you to fill out this form carefully and fully, this will help us cater your experience for you! It should only take a few minutes too :)
Child Names
*
Childs Date of Birth
*
Please select a day
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Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2021
2020
2019
2018
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1944
1943
1942
1941
1940
Year
Gender
Please Select
Male
Female
Gender Diverse
Address
Street Address Line 2
State / Province
Postal / Zip Code
E-Mail
*
Emergency Contact 1
*
First Name
Last Name
Emergency Contact Number 1
*
-
+852
12345678
Relationship
Emergency Contact 2
*
First Name
Last Name
Emergency Contact Number 2
*
-
Area Code
Phone Number
Relationship
Sight
Perfect
Fine (minor short or long sighted)
Ok (needs corrective lenses for most things)
Poor (needs corrective lenses at all times)
Physical Condition
Excellent
Fine
Ok
Poor
Emotional & Behavioural
Autistic Spectrum
Special Education Needs
ADHD
Anxiety
Depression
None of the above
Further information
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Allergies
Medicine (please provide details below)
Lactose (Dairy)
Gluten
Plant
Animal or Insect
None of the above
Other
Level of Allergic Reaction
Please Select
Minor - skin irritation
Major - hives, large rash
Severe - anaphylaxis
Do You Carry an EpiPen?
Please Select
Yes
No
Do You Carry an Asthma Inhaler?
Please Select
Yes
No
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How would you describe your swimming ability?
Poor/Cant Swim
Ok, can swim a bit, prefer using a float
Fine, can Swim without using aids
Excellent
Any other information
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Do you give permission for staff to take photos and videos for marketing purposes
Yes
No
Please write your name to confirm all details on this form are true and correct.
Type name
Submit
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