Laser Tag and Bowling at Newport Disco Bowl -

Wednesday the 2nd of November 2026

First Name of Young Person

Last Name of Young Person

Please list any allergies, additional needs or information to help us support your young person

Also we have ordered Pizza at the disco bowl

Emergency Contact number

Contact Email Address

Young Persons Date of Birth

Full Adress Including Postcode

Name of Parent

Parental Consent Section

By ticking this box I give permission for my child to attend Newport Discobowl with the Pontymoile Youth Club
By Checking this box I give permission for my child to be transported in the youth clubs minibus
by checking this box I give permission for my child to receive emergency first aid if required
by checking this box I give permission for Photos and other media to be taken of my child for promotional use of the group including use on social media

I need help getting to the meeting place at Pontymoile Community Centre

Tick this box if getting to the pick up point at Pontymoile Community Centre and you would like transport from home or a meetting place

Tick this box if you need transport from home or a different meeting place

If transport is required from home or anther place please provide address or name of place