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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
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Special Need??
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Address
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Town/City
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Postcode
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Telephone/Mobile
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Email Address
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Date of Birth
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DD
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YYYY
Gender
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Family Information
Parents name
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Parents Contact Number
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Alternative Contact Number
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INDIVIDUAL SESSIONS (Hourly Sessions)
4 x MONTHLY £100.00
8 x MONTHLY £200.00
12 x MONTHLY £300.00
Other:
CHOOSE DAYS
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Morning Sessions (9-12 noon)
Late Afternoon Sessions (12- 6 pm )
All day
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Morning Sessions (9-12 noon)
Late Afternoon Sessions (12- 6 pm )
All day
How did you hear about us?
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Payment Options through our bank details ok below. Please pay Nat west Bank Account No: 52834840 Sort Code: 600137
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