EmailMe Form - Extra Curricular School Clubs

Name of Child *
First Last
Date of Birth *
DD / MM / YYYY
Name of School Child Attends
Club Details *
Please confirm the activity you would like to book onto
Class
Year Group
Existing Medical Conditions
After Club Finishes
Parent Name *
First Last
Name of parent who is picking up the named child from the activity
Contact Number
Email *
Credit/Debit Card Number *
Long card number on the front of your card
Expiry Date
Credit/Debit Card Expiry Date
Credit/Debit Card Security Number *
Last three didgits of the security code on the reverse of your card