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 to: Active Coaching 14 Harefield East Leake Loughborough LEICS LE12 6RE
* Required Field
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):
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