Tailwaggers Ipswich Course Sign-up

Child's name*
First name Surname Age

Please press the + symbol at the end of the row to add additional atendees
Parents name*
First Last
Address*
Street Address Suburb Stare Post code Country
Phone*
Email*
School*
Year level*
Emergency contact name*
First Last
Home phone
Work phone
Mobile*
Is your child currently on medication?*
- Yes
- No
If yes, please provide details
Does your child have any allergies?*
- Yes
- No
If yes, please provide details
Does your child have Athsma?*
- Yes
- No
If yes, please provide details
Any current or pre-existing injuries?*
- Yes
- No
If yes, please provide details
Is your Child's tetanus vaccination current*
- Yes
- No
Do your animals have current vaccinations?*
- Yes
- No
- Not applicable
Does your child have any special learning or behavioural needs that we should be aware of?*
- Yes
- No
If yes, please provide details
Other: Please include any other information regarding medical history or other relevant information should medical attention be required
Please note: Medical information is required in case of an incident requiring first aid or other medical attention. Should your child require medication during their time at the Animal Welfare League of QLD, please ensure that your child is aware of the dosage and how to administer appropriately. Animal Welfare League staff will not be responsible for the administration of any medication.
I give permission for my child to be photographed for AWLQ promtional purposes*
- Yes
- No
Ticketing
Tickets*
- 1- ticket - Tuesday 24th Sept Tail Waggers Course
- 2- tickets - Tuesday 24th Sept Tail Waggers
- 3- tickets - Tuesday 24th Sept Tail Waggers
- 4- tickets - Tuesday 24th Sept Tail Waggers
1 ticket per child for the Tues 24th Sept Tail Waggers Course at Ipswich. $40 per ticket.

First name	Surname	Age

Tailwaggers Ipswich Course Sign-up

Ticketing