Application Form

Name & Contact Details

(This form may be used for 3 children in the same family)

*Child 1 Details:
Name:
DOB:
Age:

Child 2 Details:
Name:
DOB:
Age:

Child 3 Details:
Name:
DOB:
Age:

*Name of Parent/Guardian:
Address:
Postcode:

Tel:

*Email:

Dates

Please tick any times you would be able to come:

The groups are for children under 3 years* from 6 months. I may need to adjust the age ranges of the groups according to numbers. Under 18m is younger, and 2 years is older. 18 to 23 months could be either, so please be flexible if your child is in this middle age range. Thanks!

12 Tuesdays at The Pearson Centre in Beeston:
9:45 (older)10:45 (younger)
8th Jan15th Jan22nd Jan29th Jan5th Feb12th Feb
Note: No groups on 19th Feb (Half Term)
26th Feb5th March12th March19th March26th March2nd Apr

I wish to book:

Qty of Sessions (1):

session/s at £5.00 (1 Child)

Qty of Sessions (2):

Session/s at £8.00 (2 Children)

Plus one-off Registration fee £5.00 per child (1st time only, dont pay it if enrolled before!)

Less credits as agreed

TOTAL: £

**Please wait for your booking confirmation and invoice before arranging payment by bank transfer**

Please Read

- Parents or carers must stay with and supervise their children in all sessions
- Places are booked on a first come first served basis each term: limited to 16 per group
- A waiting list will operate if necessary.
- Babies up to 6 months may of course come along free of charge with an older child
- If you have 2 children whose ages put them in different groups, do bring both to an older group
- *Children may continue in the group for the rest of the half term in which they turn 3
- Payment is required in advance (or at the first session of term), in full or in instalments, preferably by bank transfer. Otherwise please make cheques payable to Wendy Prevezer, or bring cash the first week.
- Registration fees go towards group insurance: you only pay this the first time you enrol each child
- It is not normally possible to refund money for missed sessions
- Sorry, but older siblings (3 years and over) cannot be accommodated.