Childs Name * First Name Last Name 1. Are you interested in Hydrotherapy Yes No How many sessions would you like (please specify if you would like multiple sessions in one week and/or spread over the two weeks Hydrotherapy is run between 8-10am. What days would suit you? Please provide several preferences in case days are booked out. Mon 25th Sept Tues 26th Sept Wed 27th Sept Thurs 28th Sept Tues 3rd Oct Wed 4th Oct Thurs 5th Oct 2. Are you interested in doing intensives with your child? Yes No Would you like a 1 or 2 week intensives? 1 week 2 week Intensives are typically run in late morning. Which days would suit? Mon 25th Sept Tues 26th Sept Wed 27th Sept Thurs 28th Sept Tues 3rd Oct Wed 4th Oct Thurs 5th Oct 3. Are you interested in Clinic-based sessions? Yes No How many sessions would you like? What days would suit your child? Mon 25th Sept Tues 26th Sept Wed 27th Sept Thurs 28th Sept Tues 3rd Oct Wed 4th Oct Thurs 5th Oct 4. Are you interested in 1:1 Bike intensives? Yes No How many sessions would you like for your child? What days would suit your child? Mon 25th Sept Tues 26th Sept Wed 27th Sept Thurs 28th Sept Tues 3rd Oct Wed 4th Oct Thurs 5th Oct 5. Would you be interested in Playground sessions? Yes No How many sessions would you like? What days would suit your child? Mon 25th Sept Tues 26th Sept Wed 27th Sept Thurs 28th Sept Tues 3rd Oct Wed 4th Oct Thurs 5th Oct 6. Please select the Group Classes you may be interested in? Mon 25th Sept - Little Athletes Tues 26th Sept - Ninja Warrior Wed 27th Sept - Basketball Thurs 28th Sept - Jungle Dance Tues 3rd Oct - Little Athletes Wed 4th Oct - Basketball Thurs 5th Oct - Jungle Dance 7. Are you interested in a Medical Adaptive Bike Trial for your child? Yes No Thank you for sending us these details. We will follow up and get back to you soon.The Aevum kids team
