Healthy Planet Library Membership Form

Wish Town Early Years
info@hp.school
hp.school

Please fill in all the particulars.

* Indicates required question

Child's First Name *

Child's Middle Name

Child's Last Name *

Child's Date of Birth *

Child's Address *

Child's Current School *

Child's Current Grade *

Emergency Contact Number *

Emergency Contact person name (Relationship with the Child) *

Parent 1's Name *

Parent 1's Contact Number *

Parent 1's email Address *

Parent 2's Name

Parent 2's Contact Number

Parent 2's email Address

Name and relationship to the child of other adults who will accompany the child to the library.

Will there be any female caregiver who might accompany the child to the library?

If yes, then has her police verification been completed?

Name of the caregiver

Please upload a copy of the Police Verification of the above mentioned caregiver

Please provide a clear photograph of your child that meets the following criteria:

Please read the Healthy Planet Library Community Guidelines and provide consent to the following statement:

Tick all that apply.

I have read the Healthy Planet Library and Imagination Studio Community Guidelines and agree to adhere to them

Please make a payment of Rs. 30,000 for the annual membership of Healthy Planet Library and Imagination Studio after clicking the save button.