1. Does your child have a health condition?
For example: Diabetes, Epilepsy, rare health condition, juvenile arthritis, chronic respitory illness
2. Is your child aged between 6 - 18 ?
Name & Address
home
Contact Details
call
smartphone
GP & Local Authority
local_hospital
Type GP Practice name and click search
location_city
Type local authority (Council) name and click search
Other Details
event
Enter your DOB, in format: dd/mm/yyyy
Account Details
alternate_email
alternate_email
lock
lock
Registration Complete!
You have successfully registered.



Thank you for completing the Helium Arts Referral Form. Your registration is now being processed. If we require any additional information, a member of our team will be in touch. We will notify you once your registration has been complete and your child is eligible to participate on our Creative Health Programme. Warm Regards, Helium Arts
Copyright © 2022 365 Response Ltd. All rights reserved.

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