Please complete as thoroughly as possible, if you would prefer to complete this over the telephone, please call 01255475001.

Once submitted we will contact you ASAP, if you are waiting on a confirmation of a placement on a course then please do check your spam and junk folders.

Question Title

1. Your full name

Question Title

2. Contact Details (Required.)

Question Title

3. NEXT OF KIN NAME (Required.)

Question Title

4. NEXT OF KIN - contact number (Required.)

Question Title

5. Relationship to Child

Question Title

6. Child 1 attending sessions (Required.)

Question Title

7. Child 2 attending sessions (Required.)

Question Title

8. Child 3 attending sessions

Question Title

9. Please list any dietary conditions here

Question Title

10. I would like to attend the following. Please note our Lego day is now full.

Question Title

11. I consent to mine and my children's personal details being kept on a secure database to be contacted by EXTRA, all data is kept confidential in compliance with GDPR.

Question Title

12. I am happy for myself and my children to be photographed during the session (For funding reports and social medial posts) (Required.)

Question Title

13. Your child/children’s information:

If you consent to us keeping personal information on your child/children (under the age of 16) on our secure database, please tick to confirm:

Question Title

14. I would like to receive updates and leaflets via email for what courses and workshops are running the following term

T