Close Encounter Booking Form

Please fill out the booking form below to complete

1. Name of Encounter *

2. Booking reference *

3. Fee Payer's Name *

4. Fee Payer's Email? *

5. Name of the first participant *

6. Date of birth of the first participant *

7. Name of the second participant (if booked)

8. Date of birth of the second participant (if booked)

9. Do the participant(s) have up-to-date tetanus injections?

10. What is the date of the participant(s) last tetanus vaccination? *

11. Please give details of any special dietary needs, allergies or medical conditions (of any participant) that we should be aware of?

12. Does anyone in the group use a Wheelchair

13. Please enter the name and phone number of the parent or guardian on the day of the Close Encounter *

14. Please give an address and postcode for the participant(s)

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