First name
Last name
Email
Mobile
1.
Your child's first name
2.
Your child's surname
3.
Date of Birth
4.
Your child's gender
Please select
Male
Female
Non-Binary
Prefer not to answer
5.
If your child has their own email, please submit it here if appropriate.
6.
If your child has their own phone, please submit it here if appropriate.
7.
What is your Childs Bar/Bat Mitzvah date?
8.
Does your child have any allergies?
9.
Does your child have any dietary requirements?
10.
Does your child have any health issues we should know about?
11.
Emergency contact name
12.
Emergency contact mobile number
13.
What School does your child attend?
14.
I consent to photos of my child attending a Step Up Program to be taken and used for Stand Up's marketing purposes.
Please select
Yes
No