The Buzz @ Dallam | Bookings

Dallam School, Heversham, Cumbria, LA7 7EH

Name

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Last

Sex

Current School Year

Date of Birth

Church Name & Location

Address

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Address Line 2

City

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Postal Code

Would like to share a room with...?

Any dietary/medical requirements

Anything else?

Media Permissions

I give permission for photo/video media of my child, to be used for publicity purposes.
I do not give permission for photo/video media of my child, to be used for publicity purposes.

Guardian's Name

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Last

Relationship to member

Guardian's Email

Guardian's Phone

Date Payment to

If you would like to pay by bank transfer our account details are…

Sort Number: 01-00-61
Account Number: 20764855
Account Name: ‘North West Gospel Partnership’.

Please put the name of the residential (‘The Buzz @ Dallam’) and the member’s surname as the reference.

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Total

£0.00