If you would like your child to attend a Kardia course, please answer the following questions and click submit.

For all other enquiries please contact us. Thank you!

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Child's name *

First

Last

Child's date of birth *

Which school do they attend? *

Which doctor's surgery are they registered with? *

Does your child have any allergies or medical conditions we should be aware of?

Parent / Guardian name *

Address *

Phone number *

Email *

Please give a brief outline of why you would like your child to attend Kardia *

How did you hear about Kardia *

• Website
• Facebook
• Instagram
• Word of mouth
• Other

If you selected other, please give more information

Please tick ALL statements below to confirm your consent *

• I give consent for my child to attend Kardia
• I agree that my child will attend every session
• I agree I will support my child by encouraging their engagement with the course

Signature *

Date *

Submit