Chameleon Order Form

Child's Name

Child's Nickname (or Preferred Name)

Gender GenderMFX

Age (yrs)

Learning Level Learning LevelBelow Age LevelAt Age LevelAbove Age Level

Allergies

Child's Interests (at least two, up to four)

Any special requirements (eg. non-verbal, hearing-impaired, any physical impairment, advanced-learner...) - please provide details

Your Name

Your Email Address

Anything else you want Lizard to know?