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First Name

Last Name

Phone

First Name of Child

Last Name of Child

Date of Birth (Child)

School Year (Child)

Emergency Telephone No

Current Club (if none please specify)

Medical Conditions i.e. Asthma (if none, please state none)

Are you happy for photos of your child to be used for the website and promotional purposes?

Yes

Are you happy to be added to our secure email database to be contacted regarding session changes etc?

Yes

Please state the centre you're applying for

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