I would like to book a place for my child on the following date (please select the required date)* I would like to book the following session for my child:*Please SelectHalf Day 9am - 12pmHalf Day 1pm - 4pmFull Day 9am - 4pm Childs Name*FirstLast Date of Birth*01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 2019201820172016201520142013201220112010year Parents Name*FirstLast Address* Street Address Street Address Line 2 Town/City County Post Code Email* Mobile Number* Work Phone Number Child’s Doctor Address and Phone Number* Child’s Dentist Address and Phone NumberEmergency Contacts We require at least two alternatives to the parent contact details. Emergency Contact 1*First NameLast Name Emergency Contact 2*First NameLast Name Emergency Contact 1 Number* Emergency Contact 2 Phone Number* Emergency Contact 1 Relationship to Child* Emergency Contact 2 Relationship to Child* Medical Information I give permission for this child to receive urgent medical treatments:*YesNo I give permission for the above child to be included in promotional photographs which may be taken.*YesNo I give permission for any quotes from the above child to be included in any promotional material.*YesNo Choose Your Payment Option*Please SelectPaypalBank TransferCheque Please select Half or Full Day payment (£20 per full day, £10 per half day)*Please Select Session TypeHalf DayFull Day TotalBank Transfer TextCheque Text I consent collecting this data and processing it according to Privacy Policy of this website.SubmitReset