Childs Name (required)

Child's Age (required)

Age Category Entered (required)
3-6 mths6-9 months9-12 months12-18 months

Parents Name (required)

Parent Telephone Number (required)

Parent Email Address (required)

Disclaimer: By signing this form you confirm that you have parental responsibility for the child mentioned.
You agree to any images of your child being used on carnival literature (website, printed etc

Parental Consent (required)

Please Enter Todays Date (required)