Under 16 Registration Form 1

Important Notice

In order to be fully registered with this practice, this form MUST be completed by the parent / guardian on behalf of the child.  Please note that children under 16 will not be registered unless a parent / guardian is also registered at the practice.

A parent / guardian will need to attend the practice with one of the following documents to complete the registration process:

  • the child's birth certificate
  • legal documents
  • photo identification

Personal Details

In order to be fully registered with this practice, this form MUST be completed by the parent / guardian. Please note that children under 16 will not be registered unless a parent / guardian is also registered at the practice.

MrMasterMissMsOther
MaleFemaleIntersex

Background Information

YesNo
YesNo
YesNo
YesNo
YesNo

School or Nursery Details