TinyTalk Registration Form

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Booking Form - TinyTalk South Derby and Ashby-de-la-Zouch - Autumn Term 2019

Thank-you for your interest in my TinyTalk classes. This form will allow you to book classes for the Autumn Term, which runs from 4th September - 13th December (13 weeks)

Term Dates
Half Term 1 – 4th/5th/6th September – 9th/10th/11th October (6 weeks)
TWO WEEK BREAK – No classes 16th/17th/18th or 23rd/24th/25th October
Half Term 2 – 30th/31st Oct/1st Nov – 11th/12th/13th December (7 weeks)

I am delighted to welcome you and hope that you enjoy learning how to teach your baby to communicate before they can talk.

For my register and insurance purposes, I require a few contact details from you. Your details will remain strictly confidential to TinyTalk and will not be passed on to any third parties. I may contact you with information about future events and classes. There are also a couple of questions about how you heard about TinyTalk. Your answers will greatly benefit the service I provide. If you would rather not provide your details online, please contact me and I will send you an enrolment form via email and you can return it to me in class.

TO BOOK A PLACE:
Please complete the details below to secure your class place. Payment can be made by bank transfer to MRS JOANNA LUCAS sort code 070436, account number 43427120 - Please use your FULL NAME as reference, or in class by cash or card payment.

1. Your surname *

2. Your first name *

3. Child's name (1) *

4. Child's date of birth (1)

YYYY

5. Child's name (2) (please use for siblings)

6. Child's date of birth (2)

YYYY

7. Your relationship to child(ren) please check one box *

Parent

Carer

Other family member

Childminder / Nanny

Other:

8. Your address

9. Your postcode

10. Home telephone number

11. Mobile telephone number

12. Email address (this will be used to send any class booking forms or future booking forms you will need to fill in. For ongoing communication please see the Privacy section) *

13. Emergency contact name *

14. Emergency contact number *

15. Additional information e.g allergies

16. Is this your first TinyTalk booking? *

Yes - this is my first booking

No - I have attended TinyTalk in South Derby or Ashby de la Zouch before

No - I have attended TinyTalk classes somewhere else

Required

17. How did you hear about TinyTalk? *

Word of mouth

Facebook

Leaflet

Google search

Other:

Required

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