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[av_contact email=’galwaydsi@gmail.com’ title=’BOOKING FORM – DSI Galway Branch CREATIVE ARTS SUMMER CAMP at District Fitness, Athenry.’ button=’Submit’ on_send=’redirect’ sent=’Your message has been sent!’ link=’page,4891′ subject=’Creative Arts Booking Form, 9 to 13 or 14 to 18′ autorespond=’Thank you for your interest in the DSI Galway Branch Creative Arts Summer Camp at District Fitness, Athenry.
We will be back in touch shortly.
If you need more info our email address for the team managing this event is galwaydsi@gmail.com
DSI Galway Branch.’ captcha=” form_align=” color=”]
[av_contact_field label=’I Would Like To Book A Place For The Week (please select one from list)’ type=’select’ options=’None select……., For 9-13 Year Olds (Mon 11th to Fri 15th July) 10.30am to 1.30pm, For 14-18 Year Olds (Mon 18th July to Fri 22nd July) 10.30am to 2.30pm’ check=’is_empty’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Child’s Age’ type=’text’ options=” check=’is_number’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Child’s Name’ type=’text’ options=” check=’is_empty’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Address’ type=’textarea’ options=” check=’is_empty’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Parent/Guardian Name’ type=’text’ options=” check=’is_empty’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Mobile No:’ type=’text’ options=” check=’is_phone’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Email Address (we will confirm place by email)’ type=’text’ options=” check=’is_email’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Alternative Contact Name & Phone No (in case of emergency) ‘ type=’textarea’ options=” check=’is_empty’ width=” multi_select=”][/av_contact_field]
[av_contact_field label=’Any Allergies, Dietary or Other Special Circumstances The Co-Ordinators Should Be Aware Of?’ type=’textarea’ options=” check=” width=” multi_select=”][/av_contact_field]
[av_contact_field label=’I Agree To Pay The €40 Fee for Week 1/Week 2 – Creative Arts Summer Camp’ type=’checkbox’ options=” check=’is_empty’ width=” multi_select=”][/av_contact_field]
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For more information, please contact the team @ galwaydsi@gmail.com
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