Club Kirikou Leigh on Sea Summer 2019
Please register your child and make payments by BACS to the Mind Your Language International,
Bank HSBC
Acc No: 01542982
SC  :  40-03-19
If you are unsure of amount to be paid, kindly call us to confirm once you have submitted your form.

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Email *
Full Name of Participant (s) *
School(s) Attended *
Age of Participant (s) *
Languages Spoken (In order of fluency) *
Sex of Participant (1) *
Sex of other participants
Parents Full Name *
Parent's email *
Parent's Mobile *
Alternative Contact person and telephone *
Postcode *
Please tick which programme you are registering for *
Required
If you are registering for specific days, please indicate the dates and times.
Please tell us any specific needs that you have (e.g specific days /times of childcare) *
Please tell us of any medical conditions/allergies/disabilities. Any regular medication to be administered? *
Who are the nominated adults who will pick up or drop off your child(ren) *
Do you consent for your child(ren)'s photo/ film  to be taken during the club. ( For our publicity) *
Payment must be made on registration by BAC's. Please use your name as reference. Indicate amount paid. *
Full Name of Person registering
Please tell us how you heard about Club Kirikou *
Required
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