Community House Booking Form Sept 23 
Please fill in this form if you would like to book a place on the courses listed below. Jacqui or Karen will contact you to confirm your place. We have also included workshops that we can provide this year, please let us know what you are interested in so we can provide them for you. 
Email *
Your Name: *
Your Date of Birth  *
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Telephone Number *
GP Surgery Name ( Please only complete if you are attending Keep Fit) The class is funded by Healthy Island Partnership
Child 1 : Name, Date of Birth & Class *
Child 2: Name, Date of Birth & Class
Child 3: Name, Date of Birth & Class
Child 4: Name, Date of Birth & Class Name
Child 5: Name, Date of Birth & Class Name
Please tick the box for the activity/activities  you would like to attend.  *
Required
Do you have any suggestions of courses/activities/events that you would like to access?
GDPR - The information collected on this form will be used in compliance with General Data Protection Regulations. By supplying information, you are giving your consent to the information being used for the schools monitoring and funding purposes for activities that are provided within the Community House. This information will be kept strictly confidential and will be deleted in accordance with the Retention Guidelines for schools.
September 2023
Today's Date *
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