Family Fun Days - The Abilities In Me

The Abilities Family Club

We are now introducing a sign up, to be part of The Abilities Family Club.

This will slowly be expand across the UK. But we are kick starting in the heart of our home county in Hertfordshire!

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Contact Number *

Email *

Date of Birth *

Gender *

Emergency Contact Name *

First

Last

Emergency Contact Number *

Allergies or Medical Conditions

e.g. asthma or epilepsy (Please specify, who in your family has the condition and what diagnosis)

Special Dietary Conditions

Intolerances/Food Allergies

Additional Physical or Emotional Support Conditions

e.g. Physical Disabilities, Autism, ASD, ADD

I give explicit consent to the holding of information about my/our child's health. *

I allow our family to be photographed during The Abilities events. *

Signed *

Date *