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Name *

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Height

Weight

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Father's Name

Mother's Name

Emergency Contact Name / Relationship *

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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.

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07470232781
07403136281
communityconneccic@yahoo.com

4 Gedling Street, Suite 39, Unit 6,
Sneinton, Market,
Nottingham, NG1 1DS

Our office is open from 10:00 to 15:00pm, Monday - Wednesday. There is an answer phone for all other times.

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 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

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Afro-dancing lessons age 5 yrs - 17 yrs

Afro-dancing lessons age 18 yrs and above

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