Club booking form

Name *

First Name

Last Name

Forthcoming events:

Please tick each of the events you wish to attend:

Tue 7 Jan - Bingo £6

Tue 14 Jan - Zest Dance £6

Tue 21 Jan - Cinderella £15 per person PREPAY ONLY

Tue 28 Jan - Skittleman £6

Tue 4 Feb - Bowling at City Bowl £18 PREPAID ONLY

Tue 11 Feb - Disco with DJ Jo Jo's crew £6

Tue 18 Feb - HALF TERM NO CLUB

Tue 25 Feb - Karaoke £6

Tue 4 Mar - Bingo £6

Tue 11 Mar - Bowling at City Bowl £18 PREPAID ONLY

Tue 18 Mar - Zest Dance £6

Tue 25 Mar - Disco with DJ Jo Jo's crew £6

Tue 1 Apr - Arts & Crafts led by Mary £6 PREPAY ONLY

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

FOOD ORDERS *

Bowling Food Order

Chicken Nuggets and chips

Beef Burger and chips

Cheese Burger and chips

Quorn Nuggets and chips

Not attending