Please Provide us with the following information on the Childs who will be participating:

First Name*
Last Name*
Date of Birth*
Sex*	Male Female
School*

Please state any medical conditions that the child has that we should know about:

# Medical Conditions#

Please provide us with the following emergency contact information:

Name*
Title
Street Address*
Address (cont.)
City
Borough
Postal Code*
Home Phone*
Other Phone
E-mail*

Please select the dates and times you wish your child to attend*:

Saturday 28th June 2008- 9.00am - 5.00pm                                      Saturday 5th July 2008- 9.00am - 5.00pm
Saturday 12th July  2008- 9.00am - 5.00pm                                      Saturday 19th July 2008- 9.00am - 5.00pm
 

During our courses LCS take photographs and videos which in future may be used for publication purposes, please specify if we have your permission to take photographic material of your child*:

Yes No