Email Address:
Parent Name:
Telephone Number:
Address:
Child's Name:
Child's Age:
Prefered Centre:
Littleover (Wednesday)
Burton (Wednesday - opening soon)
Ripley (Thursday)
Chellaston (Friday)
Derby Central (Saturday centre opening soon)
Prefered Session Date:
Previous Arts Experience:
Additional Information:
(Please inform us of any disabilities, health problems or learning difficulties)
Please note: Once your form is submitted we will contact you to confirm a taster session date.
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