BTF 2008 Registration Form

First Name
Last Name
Gender
Date of Birth (dd/mm/yyyy)
School
School Grade
Parents name

Street number
Street name
Suburb/City
Post code
State	Victoria

Email address
Telephone (H)
Telephone (M)

For catering purposes:
Days attending BTF
No. of people attending celebratory lunch (including children) (Whole family is invited)
No. of people attending Day 3 (including children) (Whole family is invited)

Medicare Card Number
Child’s reference number on Medicare Card
Relevant Medical History and Allergies
Emergency contact name
Emergency contact number
How did you find out about Born To Fly?


Should it be necessary for the child to receive medical attention, I hereby give HANDS OF HOPE permission to use it’s judgment in obtaining the best of such service as it is required. I understand that any cost incurred will be my responsibility.
I allow photos and video images of my child to be taken for publicity purposes