MEET SKYE FROM PAW PATROL AND PADDINGTON ON THURSDAY 3rd JUNE
PLEASE REGISTER YOUR INTEREST BY COMPLETING THIS FORM. SELECT YOUR PREFERRED TIME SLOT BELOW. YOU'RE WELCOME TO MEET BOTH CHARACTERS AND WE WILL TRY TO ACCOMMODATE.
Patient Information
Full Name
First Name
Last Name
Date of birth
-
Day
-
Month
Year
Date
Gender
Female
Male
Patient condition(s)
Is your child currently receiving hospital treatment?
Yes
No
If yes, please indicate which hospital below
Evelina
GOSH
St Mary's Hospital
The Royal London
UCLH
RNOH
The Royal Marsden
Noah's Ark
The Royal Brompton
St George's
Kings College
University Hospital, Southampton
The Whittington Hospital
Nottingham Children's Hospital
Other
Choose which hospital
Parent Information
Name
First Name
Last Name
Phone Number
-
Prefix
Phone Number
Email
example@example.com
Device Name
This is the name that appears on your screen when joining a Zoom session.
Please choose your preferred slot to meet SKYE from Paw Patrol
Please choose your preferred slot to meet PADDINGTON
Additional Comments
Please verify that you are human
*
SUBMIT
Should be Empty: