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EBCC Expressions of Interest Form 2024
Please complete this form to express your interest in attending our groups and/or courses. Our team will then be in touch as and when groups are programmed and when spaces occur - please note this may not be straight away. You can check our current timetable and group information here:
https://www.eastbristolchildrenscentre.co.uk/timetable
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* Indicates required question
Form completed by
*
Self (eg. parent/carer)
EBCC Staff
Partner/Professional
Partner/Professional Name:
Your answer
Parent/Carer Name:
*
Your answer
Parent/Carer Surname:
*
Your answer
Parent/Carer Email Address:
*
Your answer
Parent/Carer Contact Number:
*
Your answer
Child's Name:
*
(type 'due date' if pregnant)
Your answer
Child's DOB:
*
(add due date if pregnant)
MM
/
DD
/
YYYY
If you are adding more than one child, then please add additional children's information as above here:
Your answer
Which Children's Centre(s) can you attend?
*
Oldbury Court
Speedwell
St Anne's Park
Broomhill
Virtual
Required
Does your family have any access requirements?
eg. require step free access, BSL interpreter, pre visit tour or anything else that would make your visit as comfortable and easy as possible.
Your answer
Communication Permission - please tick the box below to agree to be contacted by EBCC:
*
Yes, I agree to be contacted by EBCC.
Required
Would you like to join our e-mailing list for regular updates?
*
Yes
No
(EBCC Staff/Partners/Professionals Use Only)
Please select what priority is most relevant to the family you are working with.
Low Priority
Medium Priority
High Priority
Clear selection
(EBCC Staff/Partners/Professionals Use Only)
Please add any additional notes and comments here.
Your answer
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