VIB After School Care Registration Form

Your information

Name of Child* Class* Name of Parent/Carer 1* Contact Number* Address* Name of Parent/Carer 2* Contact Number* Address

Emergency Contact Details

Name - Emergency Contact 1* Emergency Contact 1 - Contact Number* Emergency Contact 1 - Address* Relationship to child* Name - Emergency Contact 2* Emergency Contact 2 - Contact Number* Emergency Contact 2 - Address* Relationship to child* Please provide a password for alternative contacts to use when collecting children