Please complete this form and submit it to book your child/children on any of the courses.
Please make cheques payable to Active Coaching and mail them to 14 Harefield, East Leake, Loughborough, LEICS, LE12 6RE.
Name of Parents * :
Address * :
Home Telephone Number * :
Emergency Telephone Number * :
Email Address * :
Details of any relevant medical condition :
Child 1 * :
Age * :
Course(s) * :
Child 2 :
Age :
Course(s) :
* Required Field