Child’s Name  ……………………………………………………………………

                       Address  ………………………………………………………………………….

                        ……………………………………………………………………………………..

                        Telephone Number/s  …………………………………………………………..

                        Age on Carnival Day  …………………….  Date of Birth  ……………………

                       School Child Attends  …………………………………………………………..

                       Parent/Guardian’s Name  ………………………………………………………

                       Signature  ………………………………………………………………………..