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Hornchurch
Romford
Upminster

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First Name *

Last Name *

Address *

Address 2 *

City *

Postcode *

Mobile Number *

If you have been referred to the Havering HAF programme please provide your UNIQUE VOUCHER CODE here (please put FSM if you are in receipt of Benefit Related Free School Meals *

Email *

Gender

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Comment

Date of Birth *

Do you have any medical conditions? *

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Please state: *

Emergency Contact Number *

Do you consider yourself to have a disability *

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Please state the nature of your diability: *

Do we have permission to take photos and use these photos on our website, promotional leaflets and social media sites? *

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Are you eligible for BENEFIT RELATED Free School Meals? *

Do we have permission to keep your personal information on file and use this data to send you information regarding future courses via email or text *

Yes

No

School Name *

Payment Information

Amount

£

By registering for this event, I accept Terms and Conditions

Upcoming events

AUG 11

SEND Para Sport Summer Activities

YMCA
AUG 12

Para Music Session

Fairkytes Arts Centre
AUG 13

Mini Athletics

Hornchurch Stadium
AUG 13

CREATIVE CLAY - Fairkytes Fun

Fairkytes Arts Centre
AUG 13

Athletics

Hornchurch Stadium
AUG 14

STREET DANCE - Fairkytes Fun

Fairkytes Arts Centre

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