Children in your care
To be completed by an adult 18+ member (parent/guardian)
Already a member? If 'No' please complete a Membership form.
*
Yes
No
Membership Number: (if known)
Name
*
First Name
Last Name
E-mail
*
Mobile Number
*
-
Area Code
Phone Number
Complete if child is under the age of 16
If 16+ please complete a membership form and waiver
Are you completing this form for a birthday party?
*
Yes
No
Name of birthday child: (or parent's name)
Date of birthday party at Portal World:
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Day
-
Month
Year
Date
Child 1
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 2
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 3
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 4
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 5
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 6
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 7
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 8
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 8
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 9
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 10
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 11
First Name
Last Name
Date of Birth
-
Day
-
Month
Year
Date Picker Icon
Child 12
First Name
Last Name
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Terms & Conditions
Liability Waiver
Please Read Terms and Conditions and Sign Below
By signing below you accept the above Portal World Terms and Conditions and Liability Waiver on behalf of the child(ren)s parent/guardian
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