Club L’Chaim - sign up form

Please complete this form to be part of Club L’Chaim’s future events and outings.

Full name (required)

Date of birth (required)

Address

Home phone number

Mobile number (required)

Best time to call you

Email address (required)

Emergency contact name (required)

Relationship (required)

Emergency number (required)

What are some things you enjoy doing? Please tick the appropriate boxes.

Cultural interests (threatre, movies, concerts, ballet, Jewish history, art and sculpture classes)Physical wellbeing (yoga, relaxation, walking, tai chi, dance)Social connections (Jewish celebrations, cafe visits, get togethers)Brain games (trivia, card games, computer lessons, book club)Creative arts (art, paining, sculpture, craft)Volunteering

If you have other interests, please describe these below

Send