Umbilical Chords - ABSS Music-Making for Southend Parents & Babies
www.southendymca.org.uk/umbilical-chords
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
County
Post Code
How many children (0-2 years of age) will you be bringing to sessions? Please provide full names and dates of birth:
We book our sessions in 6-week blocks, would you prefer to attend on a Wednesday or a Thursday?
*
Wednesday (12:30-14:00) - Southend YMCA Eco Hub, Westcliff-on-Sea
Thursday (12:30-14:00) - Southend YMCA Eco Hub, Westcliff-on-Sea
Available for either
Have you previously accessed ABSS services or filled out one of their registration forms?
*
Yes
No
Not sure
Where possible, we are asking participants to take in a weekly rapid flow Covid-19 test before attending our sessions. This is not mandatory but helps us keep everybody safe. Are you happy to comply with this?
*
Yes
No
Other
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