Pathfinder Registration Form – Leicester Central Seventh-day Adventist Church

a. What's your Email Address? *
Moving forward, certain information maybe shared via email

b. Your First Name ? *

c. Your Surname ? *

d. What's your Address, ? *
For Example: 2 University Road, Leicester, LE2 1EF

e. Your mobile number? *

f. Is there another Parent or Guardian you would like us to contact in your absence?

Yes

No

g. Other Parent/Guardian First Name? *

h. 's Surame? *

i. Is 's address different to your address? *

Yes

No

What is 's address? *

j. 's mobile number? *

k. What's Email Address? *

2 ➔ Now it's about your child/children, .

a. How many children would you like to register? *
1, 2 or 3 children's

3 ➔ Please fill in all the fields as acuratley as you can .

a. Child's First Name? *

a.1 First child's First Name? *

a.2 Second child's First Name?

a.3 Third child's First Name?

b. Child's Second Name? *

b.1 First child's Second Name? *

b.2 Is 's surname the same as

Yes

No

's Second Name?

b.3 Is 's and 's surname the same as ?

Yes

No

's Second Name?

d. When was born? *

d.1 When was born? *

d.2 When was born? *

d.3 When was born? *

f. Which address does live at? *

f.a Which address does live at? *

f. Do and live at the same address?

Yes

No

f.a Which address does live at? *

f. Do , and all live at the same address?

Yes

No

f.a Which address does live at? *

f.b Which address does live at? *

g. What is email address?
This is your child's email address, not your own. If you child doesn't have an email address, please leave blank

g.1 What is email address?
This is your child's email address, not your own. If you child doesn't have an email address, please leave blank

g.2 What is email address?
This is your child's email address, not your own. If you child doesn't have an email address, please leave blank

g.3 What is email address?
This is your child's email address, not your own. If you child doesn't have an email address, please leave blank

h. What is mobile number?
This is your child's phone number, not your own. If you child doesn't have an number, please leave blank

h.1 What is mobile number?
This is your child's phone number, not your own. If you child doesn't have an number, please leave blank

h.2 What is mobile number?
This is your child's phone number, not your own. If you child doesn't have an number, please leave blank

h.3 What is mobile number?
This is your child's phone number, not your own. If you child doesn't have an number, please leave blank

i. Dose take any medication? *

Yes

No

Please specify? *
Shift ⇧ + Enter ↵ to make a line break

i. Do either or take any medication? *

Yes

No

Please specify which child and which medication? *
Shift ⇧ + Enter ↵ to make a line break

i. Do either , or take any medication? *

Yes

No

Please specify which child and which medication? *
Shift ⇧ + Enter ↵ to make a line break

j. Dose have any allergies?

Yes

No

Please specify?
Shift ⇧ + Enter ↵ to make a line break

j. Do or have any allergies?

Yes

No

Please specify which child and which allergies?
Shift ⇧ + Enter ↵ to make a line break

j. Do , or have any allergies?

Yes

No

Please specify which child and which allergies?
Shift ⇧ + Enter ↵ to make a line break

k. Dose have any behavioural disorders?

Yes

No

Please specify?
Shift ⇧ + Enter ↵ to make a line break

k Do or have any behavioural disorders?

Yes

No

Please specify which child and which behavioural disorders? *
Shift ⇧ + Enter ↵ to make a line break

k Do , or have any behavioural disorders?

Yes

No

Please specify which child and which behavioural disorders? *
Shift ⇧ + Enter ↵ to make a line break

l. Dose have any learning difficulties?

Yes

No

Please specify?
Shift ⇧ + Enter ↵ to make a line break

l. Do or have any learning difficulties?

Yes

No

Please specify which child have learning difficulties? *
Shift ⇧ + Enter ↵ to make a line break

l. Do , or have any learning difficulties?

Yes

No

Please specify which child have learning difficulties? *
Shift ⇧ + Enter ↵ to make a line break

m. What is the name of 's GP?

m. What is the name of GP?

m.a Do or share the same GP? *

Yes

No

m.b What is the name of GP?

m. Do , or share the same GP? *

Yes

No

m.a What is the name of GP?

m.b What is the name of GP?

n What is the name of GP's practice? *

n.a What is the name of GP's practice? *

n.b What is the name of GP's practice? *

o.1 What is the GP's practice address?
Shift ⇧ + Enter ↵ to make a line break

o.1 What is 's GP's practice address?
Shift ⇧ + Enter ↵ to make a line break

o.2 What is 's GP's practice address?
Shift ⇧ + Enter ↵ to make a line break

o.3 What is 's GP's practice address?
Shift ⇧ + Enter ↵ to make a line break

p.1 What is a contact number for 's GP? *

P.1 What is a contact number of 's GP? *

P.2 What is a contact number of 's GP? *

P.3 What is a contact number of 's GP? *

s. Which school does attend? *

s. Which school does and attend? *

s. Which school does , and attend? *

t. What year is in? *

t.1 What year is in? *

t.2 What year is in? *

t.3 What year is in? *

u. What size clothes does wear? *
This is based on children sized clothing, not adult size

u.1 What size clothes does wear? *
This is based on children sized clothing, not adult size

u.2 What size clothes does wear? *
This is based on children sized clothing, not adult size

u.3 What size clothes does wear? *
This is based on children sized clothing, not adult size

4 ➔ Please pay for your children(s) registration.

Please pay £25 for

Price: £25.00

Please pay £45 for and

Price: £45.00

Please pay £60 for , and

Price: £60.00

Pay with Card (Stripe)