Abbotsford Anglican
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A Fresh Start
AKK Registration Form
*
Indicates required field
Child's Name
*
First
Last
School
*
DOB
*
Yr at School
*
Gender
*
Female
Male
Parent/Carer's Names
*
First
Last
Contact Email Address
*
Emergency Contact Phone
*
Medical conditions, allergies, dietary requirements
*
I wish, and give my permission, for AKK Leaders to meet my child at the Blackwall Pt Rd school gate and accompany my child to AKK
*
Yes
No
I give my permission for my child to be picked up after AKK by another authorised parent
*
Yes
No
Authorised Adult
*
First
Last
Contact Phone
*
I give my permission for my child to have their photo taken at AKK
*
Yes
No
How did you hear about AKK?
*
Internet
School
Friend
Other
Signature of Parent or guardian
*
Submit