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Jungle Jamboree

Child's name::*
Address::*
Age::*
Date of Birth::*
Name of parent/guardian::*
Emergency contact number::*
E-mail address::*
Any medical requirements (or type "none"):*
Doctor's name and address::*
I am happy for my child to attend the Holiday Club:*	Yes No
I give my permission for my child to be photographed and the photographs to be displayed, and used on the website:*	Yes No
Parent/guardian's permission (please print full name)::*
Date::*
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	Jungle Jamboree
	Going Bananas