Child's name *

First Name

Last Name

Childs Date of Birth *

MM

DD

YYYY

Session that you are registering for: **BURGESS HILL, (TITANS) 4pm Tuesday** *

Note: this session is at The Triangle Leisure Centre, Please double-check that the above is your preferred group. If not, please return to the previous page and select the option for the group you would like to attend regularly. Although you can switch between groups with one subscription, we require you to register for one specific group. WHEN WOULD YOU LIKE TO START? (please select below) You are welcome to attend the next available session; however, if you would like to delay your start date, please pick your preferred date instead. Please turn up on this date (you don't need to wait for us to contact you).

MM

DD

YYYY

Parents address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent 1 name *

This should be the person most likely taking the child and/or organising the child.

First Name

Last Name

Parent 2 name (if applicable)

First Name

Last Name

Parent 3 name (if applicable)

This could be a Grandparent who takes the child to the session

First Name

Last Name