Emergency Contact

Booking Info

Kindly provide the email address used when booking the event, as well as the date of the event.

Booking Email Address*

IMPORTANT! Please provide the email address that was used to complete the event booking. You can confirm which email address was used for the booking by searching for the Spark4Kids Booking Information email in your email account.

Enter Booking Email Confirm Booking Email

Event Date*

If you have booked more than one event, please select the first event that will be attended.

Emergency Contact 1 - Details

Please ensure that the Emergency Contact details provided here are correct, and also that the contact is immediately reachable for the dates/times when your child is/your children are with Spark4Kids.

Emergency Contact 1 - Name*

Emergency Contact 1 - Telephone*

Emergency Contact 1 - Email*

Emergency Contact 1 - Address*

Do you have another Emergency Contact to add?*

Yes, I have a second Emergency Contact
No, no more to add

Emergency Contact 2 - Details

Please ensure that the Emergency Contact details provided here are correct, and also that the contact is immediately reachable for the dates/times when your child is/your children are with Spark4Kids.

Emergency Contact 2 - Name*

Emergency Contact 2 - Telephone*

Emergency Contact 2 - Email*

Child 1 - Details

Details of the child who will be attending the computer coding course

Child 1 - Name*

Child 1 - Gender*

Child 1 - Date Of Birth*

Child 1 - Medical Notes*

Allergies, known medical issues, dietary requirements, learning difficulties (please list all). Please enter 'None' if there are no issues.

Do you have a second Child attending?*

Yes, I have a second Child to add
No, no more to add

Child 2 - Details

Details of the second child who will be attending the computer coding course

Child 2 - Name*

Child 2 - Gender*

Child 2 - Date Of Birth*

Child 2 - Medical Notes*

Allergies, known medical issues, dietary requirements, learning difficulties (please list all). Please enter 'None' if there are no issues.

Do you have a third Child attending?*

Yes, I have a third Child to add
No, no more to add

Child 3 - Details

Details of the third child who will be attending the computer coding course

Child 3 - Name*

Child 3 - Gender*

Child 3 - Date Of Birth*

Child 3 - Medical Notes*

Allergies, known medical issues, dietary requirements, learning difficulties (please list all). Please enter 'None' if there are no issues.

Do you have a fourth Child attending?*

Yes, I have a fourth Child to add
No, no more to add

Child 4 - Details

Details of the fourth child who will be attending the computer coding course

Child 4 - Name*

Child 4 - Gender*

Child 4 - Date Of Birth*

Child 4 - Medical Notes*

Allergies, known medical issues, dietary requirements, learning difficulties (please list all). Please enter 'None' if there are no issues.

Confirmation of Action - In Case of Emergency

Please tell us what you want us to do in case of emergency. Regardless of your choice below, Spark4Kids will get in touch with the Emergency Contact(s) whose contact details are listed above.

Confirmation of Action in Case of Emergency:*

In the event that any or all of my children require immediate medical treatment before I can get to the hospital, I HEREBY AUTHORISE staff members present to consent to any emergency medical treatment necessary to ensure the health and safety of any or all of my children on my behalf.
I DO NOT AUTHORISE staff members to consent on my behalf, and I will make my own arrangements in case of emergency.

Confirmation of Action In Case of Emergency (enter your name)*

IMPORTANT: Entering your name below acts as an Electronic Signature, and indicates acceptance of the above Confirmation of Action in Case of Emergency.

Date of Confirmation of Action In Case of Emergency*

Please date your Electronic Signature.

Human or Robot? What is the answer when 7 is taken away from 9?*

21
2
32

Email

This field is for validation purposes and should be left unchanged.

Booking Info

Emergency Contact 1 - Details

Emergency Contact 2 - Details

Child 1 - Details

Child 2 - Details

Child 3 - Details

Child 4 - Details

Confirmation of Action - In Case of Emergency

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