HOLIDAY REG. FORM
Hello and welcome to our registration page.
Thank you for signing up for our exciting program.
All geared towards building confidence and higher self-esteem.
It will be full of fun
Please call 07555183177 for any questions
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REGISTERATION
Childs Name and Date of Birth *
Special Need?? *
Address *
Town/City *
Postcode *
Telephone/Mobile *
Email Address *
Date of Birth *
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YYYY
Gender *
Family Information
Parents name *
Parents Contact Number *
Alternative Contact Number *
INDIVIDUAL SESSIONS (Hourly Sessions)
CHOOSE DAYS
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Morning Sessions (9-12 noon)
Late Afternoon Sessions (12- 6 pm )
All day
How did you hear about us?
Payment Options through our bank details ok below. Please pay Nat west Bank Account No: 52834840 Sort Code: 600137
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