A Play With Nature - Halloween Fun
Registration Form
Participant's name
*
First Name
Last Name
Participant's date of birth
*
Additional participant's name, if applicable
First Name
Last Name
Additional participant's date of birth, if applicable
Parent/Guardian name
*
First Name
Last Name
Parent/Guardian phone number
Format: 00000000000.
Parent/Guardian Email:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency contact name
*
First Name
Last Name
Emergency contact number
*
Format: 00000000000.
Enrolment and Payment
*
prev
next
( X )
A Play With Nature - Halloween Fun - Holmer Green Village Centre - THURSDAY 30th OCTOBER 2025
£40.00
£
40.00
Quantity
1
2
3
4
5
6
7
8
9
10
A Play With Nature - Halloween Fun - Holmer Green Village Centre - THURSDAY 30th OCTOBER 2025 - Discounted Sibling
£36.00
£
36.00
Quantity
1
2
3
4
5
6
7
8
9
10
Payment Methods
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Health information (if enrolling siblings, please include information for all participants)
*
Rows
No
Yes
If yes, please explain.
Does your child have any restrictions regarding physical activity?
Will your child need any special assistance during the sessions?
Does your child have any allergies?
Does your child require/carry an EpiPen?
Is there there anything else you feel we should know about your child?
Please note that we cannot give your child/ren over-the-counter or prescription medication whilst in our care.
*
Rows
No
Yes
I acknowledge and accept.
Photo and Filming Permission
Rows
Yes
No
I give permission for photographs and video of my child/ren to be used on Simply Drama and Nurture Nature Collective's websites.
I give permission for photographs and video of my child/ren to be used on Simply Drama and Nurture Nature Collective's social media pages.
I understand that these videos/photos will be stored securely and used only for the purposes stated above.
Signature
Print Form
Submit
Submit
Should be Empty: