Dads count registration form
which age group do you wish to book
*
8-12
12+
Childs name
*
First Name
Last Name
Parents name
*
First Name
Last Name
Childs Gender
*
Male
Female
I consent to (named child) being filmed and photographed for the Holiday Activity Fund promotional film. The footage or pictures may be used for evidencing the positive outcomes of the programme to the Department for Education, on Kirklees Council internal and external websites and in staff training events. Children and young people will not be named in the videos. Footage or photos may be of groups/at a distance or of young people speaking directly to the camera.
*
Yes
No
Back
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Email Address
*
Parents / Guardian Name
*
First Name
Last Name
Phone Number
*
Emergency Phone number
*
Post Code
*
Any SEN /Disability /allergies/ dietary needs
*
yes
no
If yes please give details
Venue address
The Zone Heckmondwike WF160EN
Submit
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