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Age :
Grade at School :
Contact Details
Parent Name : Address : Tel (H) : Email : Emergency Contact :
Tel (M) :
Do you consent to medications being administered to this child in case of an emergency? YES/ NO Are there any allergies or medical condition that we need to be aware of?
__________________________________________________________
I give permission to my child/children to attend the VBS. Parent / Guardian Signature : Date :
Should you require more forms - Please visit our website www.perthmarthoma.org.au