Activity Booking Form

Please provide the details of the individual being registered below; once submitted, there will be a link to pay the registration fee.

Name *

Date of Birth

Address *

Contact Number *

Email Address *

Age *

Gender

Any health conditions?

Any disabilities?

Height

Weight

Religion

Language

Father's Name

Mother's Name

Emergency Contact Name / Relationship *

Emergency Contact's Number *

Please make sure you have registered your interest with us before making a booking.

Name *

Date of Birth

Address *

Phone number *

Email *

Select Activity *

Community Connect HUB | Multicultural Enrichment, East Midland | Cultural Afro-Dancing Lessons Nottingham | Affordable Housing Support Derbyshire