Your Name (required)
Your Email (required)
Your Telephone: (required)
Your Relationship to Child: (required)
Child's Full Name (required)
Child's Date of Birth (dd-mm-yyyy) (required)
Child's Home Address and Postcode (required)
Emergency Contact 1 (required)
Emergency Contact 1 Number (required)
Emergency Contact 2 (required)
Emergency Contact 2 Number (required)
Leisure Card Number (if applicable)
If your child is 8 or over, do you give permission for them to participate in swimming activities?
Do you consider your child to have a disability?
Physical ImpairmentLearning DisabilityDeaf/Hard of HearingBlind/Partially SightedOther
Which site would you like to book?
Denbigh Leisure CentreLlangollen Leisure CentreRhyl Leisure CentreRuthin Leisure Centre
Date & Activity you wish to book (required)
Please list each individual date you wish to book
Are you happy for your child to be involved in any group photographs?
By ticking this box, I confirm that I have read the parent’s guide and agree to follow all procedures stated
Please note that a member of the team will contact you to take payment.