Patient Name *
Contact Number *
Where You Stay?
My reason for contact:
I consent KnowledgeHut dementia awareness service to give my details (name , address & contact number only) for awaring me about dementia.
Your Name *
Your School Year * —Please choose an option—Year 1Year 2Year 3Year 4Year 5Year 6Year 7Year 8Year 9Year 10Year 11Year 12
Choose Subject * —Please choose an option—Math, Science & EnglishArabicBoth
Post code *
Select Branch * —Please choose an option—Branch 1 - Becontree Heath Methodist Church, The Broadway, Dagenham, RM8 1DZBranch 2 - Parkside Community Association, 176 Goodmayes Lane, Ilford, Essex, IG3 9PPBranch 3 - St Bartholomew's Church, 292b Barking Rd, East Ham, London E6 3BA
Lesson Starting Time* Every Saturday 10.0 am - 12.0 pm
Lesson Starting Time* Every Sunday 10.0 am - 12.0 pm
Lesson Time* Every Saturday 2.0 pm - 4.0 pm
Thank you. You have registered successfully!
