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Hornchurch
Upminster

Join waitinglist

First Name *

Last Name *

Address *

Address 2 *

City *

Postcode *

Mobile Number *

If you have been referred to the Havering HAF programme please provide your UNIQUE VOUCHER CODE here (please put FSM if you are in receipt of Benefit Related Free School Meals *

Email *

Gender

Male

Female

Comment

Date of Birth *

Do you have any medical conditions? *

Yes

No

Please state: *

Emergency Contact Number *

Do you consider yourself to have a disability *

Yes

No

Please state the nature of your diability: *

Do we have permission to take photos and use these photos on our website, promotional leaflets and social media sites? *

Yes

No

Are you eligible for BENEFIT RELATED Free School Meals? *

Do we have permission to keep your personal information on file and use this data to send you information regarding future courses via email or text *

Yes

No

School Name *

Payment Information

Amount

£

By registering for this event, I accept Terms and Conditions

Upcoming events

JAN 07

Disability Athletics Sessions

YMCA
APR 01

SUPER EASTER SLIME TIME! - Fairkytes Fun

Fairkytes Arts Centre
APR 08

Mini Athletics

Hornchurch Stadium
APR 08

MARVELLOUS MASQUERADE MASKS - Fairkytes Fun

Fairkytes Arts Centre
APR 08

Athletics

Hornchurch Stadium
APR 09

BABY ANIMALS AIR DRY CLAY - Fairkytes Fun

Fairkytes Arts Centre

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