Register for the HemiHelp Activity Day

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Welcome to the registration form for the HemiHelp Activity Day.

Please could you complete and submit the information below, ensuring you add your contact telephone number or email address.

At the end of each working week, we will contact those registered during the week with confirmation of a place at the HemiHelp Activity Day.

Those who are unsuccessful for this year's Activity Day are automatically registered for next year's event.

Please enter the full name of your child with hemiplegia
Please enter the child's age
Please enter either the mother's or father's name
Your street address
if you need an additional line
Please enter your town
Please enter your county
Please enter your postcode
Please enter a contact telephone number
Please enter a contact email address
Please enter the names of brothers and sisters who will also attend
Submitted by Jonathan Furness on Wed, 2006-04-26 11:27.
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