Enrolment form

    PERSONAL AND CONTACT DETAILS

    The personal information on this form will be held securely and will only be shared with teachers or others who need this information in order to meet your specific needs.

    Participant name

    Date of birth
    Gender
    Parent/guardian's name
    Address

    Your Email (required)

    Contact number (home)

    Contact number (mobile)
    First emergency contact

    Relationship to participant

    Contact number (home)

    Contact number (mobile)

    Second emergency contact

    Relationship to participant

    Contact number (home)

    Contact number (mobile)



    I would like to book the following class/classes

    Class (required)
    Day (required)
    Time (required)
    Class
    Day
    Time

    Class
    Day
    Time

    MEDICAL/HEALTH INFORMATION

    Please give details of any medical condition or disability/special/additional needs that the club should be aware of *:

    Please give details of any allergies:

    School

    Childcare Voucher Provider
    Payment Amount
    Payment Method
    Date payment/transfer made

    Payment by cash or cheque must be accompanied by a completed rebooking form in a sealed envelope with the correct money enclosed.
    Cash or Cheque - Please pay to your class teacher

    Bank Transfer – Please use your child’s name and class for a reference
    Twisters
    RBS
    Acc: 19323912
    Sort code: 83-04-25

    If this is your first trial class please select here
    Trial

    Childcare Vouchers

    Ofsted number; EY449419
    Ofsted registered Address
    St Johns Church
    Mattock Lane
    Ealing
    London W13 9LA

    CONSENTS

    Participation

    Medical

    Photography (Optional)
    YesNoI consent to being photographed/ video footage whilst participating in club activities/events and for these images to be used to promote the club in newspaper articles and other media such as the club websites, information leaflets, electronic newsletters and presentations. I understand that I can withdraw consent at any point. Please note that we will be unable to remove
    images that have already been used in publications or publicity material.

    Privacy

    Signed


    Date

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