Club booking form

Name *

First Name

Last Name

Forthcoming events:

Please tick each of the events you wish to attend:

Tue 10 Sept - Zest Dance £6

Tue 17 Sept - Quiz with Tom £6

Tue 24 Sept - Reptile Encounter £6

Tue 1 Oct - Bingo £6

Tue 8 Oct - Bowling at City Bowl £18 MUST BE PREPAID

Tue 15 Oct - Disco with DJ Jo Jo's crew £6

Tue 22 Oct - Tickled Pink (Jersey Pack) £6 PREPAY

Tue 5 Nov - Zest Dance £6

Tue 12 Nov - Karaoke £6

Tue 19 Nov - Disco with DJ Jo Jo's crew £6

Tue 26 Nov - Tickled Pink (Winter Wonderland) £6 PREPAY

Tue 3 Dec - Bowling at City Bowl £18 MUST BE PREPAID

Tue 10 Dec - Christmas Arts & Crafts £6. PREPAY

Will you be attending with or without a carer? *

Please select one from the list below:

Without a carer

With a parent/carer

With an essential carer

Please tick here if you are a wheelchair user:

How will you be paying? *

Please select one from the list below:

Via PayPal Please select friends and family (see link below)

Direct Bank Transfer (Please contact us for bank details.)

Cheque Made payable to: Grapevine Essex and posted to: Grapevine Essex, c/o 130 Arbour Lane, Chelmsford, CM1 7RW

I would like Penderel's Trust/ECC to be invoiced directly

I will pay cash at club

FOOD ORDERS

Bowling Food Order

Chicken Nuggets and chips

Beef Burger and chips

Cheese Burger and chips

Quorn Nuggets and chips