Booking Form
Which summer activity would you like to book?
(Please tick the relevant box/ boxes)
Haf Fun!
12th, 13th or 14th August - Fun and dance for 0-6 year olds, 9.45 - 12.15pm. Children under 4 must be accompanied by an adult, £5.
Name of participant *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Age *
Your answer
Address *
Your answer
Name of Parent *
Your answer
Address *
Your answer
Telephone Number *
Your answer
Mobile
Your answer
Email Address
Your answer
Health and Safety *
All Powys Dance staff have received emergency first aid. Do you (your child) have any medical conditions or impairments that we need to be aware of?
If yes to the above, please give details
Your answer
Emergency contact name *
Your answer
Emergency contact number *
Your answer
Relationship to the participat *
Your answer
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