Club booking form

Name *

First Name

Last Name

Forthcoming events:

Please tick each of the events you wish to attend:

Tue 22 Apr - Reptile Encounter £6

Tue 29 Apr - Bingo £6

Tue 6 May - Games Night £6

Tue 13 May - Disco with DJ Jo Jo's crew £6

Tue 20 May - Bowling at City Bowl £18 PREPAID ONLY

Tue 27 May - HALF TERM NO CLUB

Tue 3 June - Big Sing / Karaoke £6

Tue 10 June - Disco with DJ Jo Jo's crew £6

Tue 17 June - Zest Dance £6

Tue 24 June - Bowling at City Bowl £18 PREPAID ONLY

Tue 1 July - Bingo £6

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

Cash to club before events

20 MAY BOWLING FOOD ORDER *

Chicken Nuggets and Chips

Beef Burger and Chips

Cheese Burger and Chips

Quorn Nuggets and Chips

N/A

24 JUNE BOWLING FOOD ORDER *

Chicken Nuggets and Chips

Beef Burger and Chips

Cheese Burger and Chips

Quorn Burger and Chips

N/A