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)
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.