Waiting List Registration Form
student's Information
Full Name
Other Names
Date Of Birth
Parent's Information
Mother's  
Full Name
Mobile Phone
Home Telephone
Home  Address
Postal Code
E-Mail  Address
Father's  
Full Name
Mobile Phone
Home Telephone
Home Address
Postal Code
E-Mail  Address
Additional information
If your child attendes school or nursery, which one ?
Does your child have any health problems that we should be aware of ?
POST ADDRESSes
1-Lough Moss Leisure Centre Hillsborough Road Carryduff BT8 8HR
2-BT11 8BL St Teresa's Youth Centre Belfast UK