Activity Days - Admission & Permission Slips

November 2011 1 Autism Concern Activity Days Admissions Form and Permission slips FAMILY DETAILS Child’s Surname:………………………………………………………… Child’s birth name:…………………………………………………………. Any other name the child is called:………………………………………… Child’s date of... More

November 2011 1 Autism Concern Activity Days Admissions Form and Permission slips FAMILY DETAILS Child’s Surname:………………………………………………………… Child’s birth name:…………………………………………………………. Any other name the child is called:………………………………………… Child’s date of birth:……………………………Age:………………………… Parent(s)’s/ carer(s) names:………………………………………………. Address: ……………………………………………………………………… ………………………………………………. Postcode………………………. Telephone(home)…………………………………. . Telephone(mum)……………………………. . Mobile: Telephone (dad) ……………………………. . Mobile: Email……………………………………………………………………………. ……………………………………………………………………………………. . Parent(s)’s place of work……………………………………………………… ………………………………………………………………………………………. ………………………………………………………………………………………… Telephone : ………………………………………………………………………………………… Names of Siblings:……………………………………Age……………………… …………………………………………………………. Age……………………… …………………………………………………………. Age……………………… Date:-____________________ Less