Kharafi Activity Kids Center Kuwait

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		Our Terms
		Child Profile Form
		Medical History Form
		Volunteers
		Application Form

CHILD PROFILE FORM :

Name:

Date of Birth :

Gender:

Male

Female

Address:

Impairment:

School:

FAMILY PROFILE FORM:

Father's Name:

Company:

Home telephone:

Mobile:

Work phone:

Mother's Name:

Company:

Home telephone:

Mobile:

Work phone:

INCASE OF EMERGENCY, PLEASE CONTACT:

Name	Relationship	Telephone
1
2

IMPAIRMENTS & HEALTH NOTES: