Vibrant Communities Summer Holiday Registration Form 2018 - Kilmarnock

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1. Child / Young Person's Registration Details

This registration process is for KILMARNOCK AREA ONLY, it will take no more than 3-5 minutes to complete. Places are limited for each activity, a member of the Vibrant Communities Team will be in contact 1 WEEK prior to the event to confirm your place.

1. Young Person's Details *

Forename	*
Surname	*
Address 1	*
Address 2
Address 3
Post Code	*
Telephone Number	*
Mobile Number	*
Email Address	*
School / College	*

2. Date of Birth *

	DD/MM/YYYY

3. Any Dietary requirements or allergies *

Yes please specify below
No

Comments:

4. Are there any medical conditions that we need to be aware of? *

Yes please specify below

No

Comments:

5. Do you wish to register any other child/young person residing at the address above? *

Yes
No