APPLICATION FORM
 Russian-speaking playgroup RUBRIC MALYSH in Telford

1.	Child’s full name 
2.	Child’s DOB 				
3.	Mother’s name and contact phone number

4.	Father’s name and contact phone number

5.	Who will be bringing and collecting your child from our group?

6.	Child’s address:

7.	Which day(s) of the week would you like your child to attend our group? 
Monday 	Tuesday 	Wednesday 	Thursday 	Friday

8.	Does your child attend an English-speaking group or pre-school?     If yes, on which days?
Monday 	Tuesday 	Wednesday 	Thursday 	Friday 
9.	Does your child have any health issues: allergies, etc.?

10.	 What language do you communicate with your child at home? 

11.	Your preferences for group’s activities, what information (subjects) would you like your child to learn in our group?  (please specify, if any)

12.	Signature and date 

Thank you!