Holiday Courses booking form

Please fill in the form below to submit relevant details:

Name of parent/guardian:
Name of child:
Email:
Date of Birth
Description (click to edit)
Mobile:
Does your child take any medication:
Yes
No
Does your child have any disabilities/special needs?
Any medical conditions (please describe)
Please state whether it is acceptable for pictures of your child to be included in the club's promotional advertising
Acceptance
Name (click to edit)
By clicking here I understand that Brabyns and its employees are not under any liability in respect of personal injury unless neglect can be shown. In the event that my son/daughter is injured whilst participating at Brabyns and I cannot be contacted on the above numbers, I hereby give my consent for my child to receive mediacl attention.
Enter the code below in here: