Little White Ribboner Enrolment

I PROMISE to teach my child not to drink alcohol, smoke, use or

experiment with any other drug not prescribed by their doctor.

A separate form is required for each child.
Give the name of your child in the space below.

Please indicate whether your child is a boy or a girl in the gender space below.

Please enter the date of birth of your child in the space below in the following format - DD/MM/YYYY.


(Please enter the text in the image above. Text is not case sensitive.)
Click here if you cannot recognize the code.

All fields are required.

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