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Application for Activity Day 2007

Fri, 06/22/2007 - 14:55 — Jonathan Furness

Welcome to the online application form for the
Stepping Stones Activity Day 2007.

Please could you complete and submit the information below, ensuring you add your contact telephone number or email address.

We will contact you to let you know if your application has been successful.

Please enter the full name of your child with hemiplegia
Please enter the child's date of birth (dd/mm/yyyy)
Please enter either the mother's or father's name
Your street address
if you need an additional line
Please enter your town
Please enter your county
Please enter your postcode
Please enter a contact email address
Please enter a contact telephone number
Please enter your mobile telephone number (if you have one)
Please enter the names AND dates of birth of other children who will also attend the day. Children aged 4 and under aren't able to participate in the programmed activities.