Ready for Physio - Registration

We want to make sure these sessions are fun and helpful. Please fill this out with your child so we can hear from both of you!

1. Basic Information

Child's Name*

Child's Date of Birth*

Child's Gender
MaleFemaleOtherPrefer not to say

Parent's Name*

Address*

Parent Email*

Parent Mobile*

4. Permissions & Consent

Permission to take photos/videos?

I give permission for Little Hiccups to take photographs and/or video of my child and/or family during sessions.
I grant Little Hiccups full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity, or other purposes to help achieve the group’s aims. This might include (but is not limited to) the right to use them in printed and online publicity, social media, press releases, and funding applications.
You have the right to opt out at any time.
I am happy for photos and video of my child and/or family to be taken:

YesNo

Consent*
By submitting this form, I certify that the above information is correct, and I agree to promptly communicate any future changes to the above prior to Physio sessions. I give my consent for my son / daughter to participate in the Physio sessions. I also confirm that to the best of my knowledge (unforeseen circumstances aside) I will be able to attend all sessions. Please keep in mind that all children must be supervised by their parent/carer at all times.

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ESSENTIAL INCLUSION CRITERIA

Ready for Physio - Registration

1. Basic Information

2. Questions for Your Child

3. Questions for Parent/Guardian

4. Permissions & Consent

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