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AliCaT Registration Form
Please fill out the form below to register your child or children
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to save your progress.
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* Indicates required question
Carer First Name
*
Your answer
Carer Last Name
*
Your answer
Child 1 First Name
*
Your answer
Child 1 Last Name
*
Your answer
Child 1 Date of Birth
*
MM
/
DD
/
YYYY
Child 2 First Name
Your answer
Child 2 Last Name
Your answer
Child 2 Date of Birth
MM
/
DD
/
YYYY
Child 3 First Name
Your answer
Child 3 Last Name
Your answer
Child 3 Date of Birth
MM
/
DD
/
YYYY
Please tick your preferred day
*
Tuesday
Wednesday
Thursday
Friday
Contact Email Main
*
Your answer
Contact Email Other
Your answer
Contact Phone Main
Your answer
Contact Phone Mobile
Your answer
Contact Phone Other
Your answer
Occupation (optional)
Your answer
Interested in volunteering to help AliCaT (optional)
Class Supervision
Set painting and construction
Technical support (lighting/sound, etc.)
Front of house (box office/bar)
Preschool storytelling
Emergency Contact First Name
*
Your answer
Emergency Contact Last Name
*
Your answer
Emergency Contact Phone
*
Please use a number that is always monitoured
Your answer
Address 1
*
e.g. house name or number
Your answer
Address 2
*
e.g. road name
Your answer
Address 3
*
e.g. city or town
Your answer
Address 4
*
e.g. postcode
Your answer
Medical and Support Needs
please add information for each child, e.g. Child 1..., Child 2..., Child 3...
Your answer
School Attending Child 1
*
Your answer
School Attending Child 2
Your answer
School Attending Child 3
Your answer
How did you find out about AliCaT?
Friend
School
Web
Word of Mouth
Add any additional information here
Your answer
Select if you would like a Free Trial Class
Free Trial Class
AliCaT Late Payments
Please be aware that if AliCaT term fees are 10 days overdue following an invoice the customer will incur a late payment charge of 10% (e.g. if the invoice is £100 the late payment will be £100 + £10).
For customers who are experiencing financial difficulties please inform AliCaT asap to arrange a suitable payment plan - this can only be agreed by the owner of AliCaT.
*
I understand and agree
I Agree to the AliCaT Terms & Conditions
*
terms link here:
https://bit.ly/2JN19I5
I agree
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