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Sensory Circuit Booking Form
To complete your registration for our Sensory Circuits, please complete the following form.
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Parent's Name completing the form
Your answer
Telephone Number
Your answer
Email Address
Your answer
Child's Name
Your answer
Child's Year Group
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year7/8
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What session have you booked online?
Monday - Sycamore Centre, Basingstoke
Tuesday - Pamber Heath Memorial Hall, Tadley
Thursday - Oakridge Hall for All, Basingstoke
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Please confirm you have made payment online. (Please include reference number here
Your answer
Do you give your consent for your child to be in any images that may be used for advertising purposes? (We will always ensure any images taken will be either behind or side profile)
Yes
No
Maybe
Other:
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Emergency Contact Information (Please include Name, Relationship to Child and Contact Number)
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How did you hear about us?
Facebook
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Directly from Website
Internet Search Engine
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