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*:

        Week 1:

Monday 21st July 2008 - 10.30am - 3.30pm                                      Monday 21st July 2008 - 8.00am - 6.00pm
Tuesday 22nd July 2008 - 10.30am - 3.30pm                                     Tuesday 22nd July  2008 - 8.00am - 6.00pm
Wednesday 23rd July 2008 - 10.30am - 3.30pm                                Wednesday 23rd July 2008 - 8.00am - 6.00pm
Thursday 24th July  2008 - 10.30am - 3.30pm                                    Thursday 24th July 2008 - 8.00am - 6.00pm
Friday 25th July  2008 - 10.30am - 3.30pm                                        Friday 25th July 2008 - 8.00am - 6.00pm

        Week 2:

Monday 28th July 2008 - 10.30am - 3.30pm                                      Monday 28th July 2008 - 8.00am - 6.00pm
Tuesday 29th July 2008 - 10.30am - 3.30pm                                      Tuesday 29th July 2008 - 8.00am - 6.00pm
Wednesday 30th July 2008 - 10.30am - 3.30pm                                 Wednesday 30th July 2008 - 8.00am - 6.00pm
Thursday 31st July 2008 - 10.30am - 3.30pm                                     Thursday 31st July 2008 - 8.00am - 6.00pm
Friday 1st August 2008 - 10.30am - 3.30pm                                      Friday 1st August 2008 - 8.00am - 6.00pm

Week 3:

Monday 4th August 2008 - 10.30am - 3.30pm                                   Monday 4th August 2008 - 8.00am - 6.00pm
Tuesday 5th August 2008 - 10.30am - 3.30pm                                   Tuesday 5th August 2008 - 8.00am - 6.00pm
Wednesday 6th August 2008 - 10.30am - 3.30pm                              Wednesday 6th August 2008 - 8.00am - 6.00pm
Thursday 7th August 2008 - 10.30am - 3.30pm                                  Thursday 7th August 2008 - 8.00am - 6.00pm
Friday 8th August 2008 - 10.30am - 3.30pm                                      Friday 8th August 2008 - 8.00am - 6.00pm

Week 4:

Monday 11th August 2008 - 10.30am - 3.30pm                                    Monday 11th August 2008 - 8.00am - 6.00pm
Tuesday 12h August 2008 - 10.30am - 3.30pm                                     Tuesday 12th August  2008 - 8.00am - 6.00pm
Wednesday 13th August 2008 - 10.30am - 3.30pm                               Wednesday 13th August 2008 - 8.00am - 6.00pm
Thursday 14th August 2008 - 10.30am - 3.30pm                                   Thursday 14th August 2008 - 8.00am - 6.00pm
Friday 15th August 2008 - 10.30am - 3.30pm                                       Friday 15th August 2008 - 8.00am - 6.00pm

Week 5:

Monday 18th August 2008 - 10.30am - 3.30pm                                    Monday 18th August 2008 - 8.00am - 6.00pm
Tuesday 19h August 2008 - 10.30am - 3.30pm                                     Tuesday 19th August  2008 - 8.00am - 6.00pm
Wednesday 20th August 2008 - 10.30am - 3.30pm                               Wednesday 20th August 2008 - 8.00am - 6.00pm
Thursday 21st August 2008 - 10.30am - 3.30pm                                   Thursday 21st August 2008 - 8.00am - 6.00pm
Friday 22nd August 2008 - 10.30am - 3.30pm                                       Friday 22nd August 2008 - 8.00am - 6.00pm

Week 6:
Tuesday 26th August 2008 - 10.30am - 3.30pm                                     Tuesday 26th August  2008 - 8.00am - 6.00pm
Wednesday 27th August 2008 - 10.30am - 3.30pm                               Wednesday 27th August 2008 - 8.00am - 6.00pm
Thursday 28th August 2008 - 10.30am - 3.30pm                                   Thursday 28th August 2008 - 8.00am - 6.00pm
Friday 29th August 2008 - 10.30am - 3.30pm                                       Friday 29th August 2008 - 8.00am - 6.00pm

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