Join a Danni Dinocorn Therapy Group

Biographical Information
Consent Form
Payment Information

We are so excited to have you join the Danni Dinocorn family! We know paperwork is a hassle, but please read and complete the following form carefully so we can provide the best service to you.

Name of Child

Last Name of Child

Name of School

Grade of Child

When would you like to attend the sessions?

Date of Birth of Child

Choose a Danni Group to Join

Name of Parent / Guardian

Last Name of Parent / Guardian

ID number of Parent / Guardian

Relation to Child (e.g. Mother, Father, etc.)

Contact Number of Parent / Guardian

Please provide us with a contact number to which you would like to receive communication in the form of WhatsApp messages. This number will be added to a group/community and will be used to communicate important weekly updates and notifications.

Please let us know if there is anything important you would like us to know aboutyour child, like medication or allergies.

Would you like a proof of payment statement at the end of the 7-weekprogramme to claim back from your medical aid?

Medical Aid Name

Main Member Full Names

Medical Aid Membership Number

Main Member ID number

Join a Danni Dinocorn Therapy Group

Consent Form

Payment Information

Helping children understand and manage their fears in a fun, relatable way.

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