OUR SERVICES
CAREERS
LATEST
CONTACT US

Become a member

Already a member? Click here to book.

Personal Information

Full Name *

Date of Birth *

Gender

Phone *

Email *

Address Line 1

Address Line 2

Town / City

Post Code

Medical Details

NHS Number *

Relevant Medical Conditions

Allergies *

Extra Requirements

Additional Assistance Requests

Medication

Will you come accompanied by a carer?Yes

GP Details

Surgery Name *

GP Address *

GP Phone Number *

Emergency Contacts

Emergency Contact 1 *

Phone Number *

Relationship *

Emergency Contact 2

Phone Number

Relationship

Day Care Preferences

Preferred Days

Consent

I understand that St Mary’s Day Care Centre will use my contact details to send me important information about my membership and bookings (for example, confirmations, changes or cancellations).

I would like to receive occasional emails with news, updates and upcoming events from St Mary’s Day Care Centre. I understand I can unsubscribe at any time.

Payment

Credit / Debit Card *

×