Little Medical School

Registration Form

"*" indicates required fields

Parent's Name*

First Last

Child's Name*

First Last

Child's School Grade*

Child's Birthday*

Mobile Number*

WhatsApp Number*

Email*

Address*

Street Name District City

What school does your child attend?*

Does your child have any allergies?*

Yes

If yes, please describe what allergies your child has

Is there anything else you would like us to know about your child?

Consent

I do give consent for my child’s photo to be taken and used for LMS Social Media and Marketing