Registration details will be emailed to the address provided during the week prior to the Playscheme week.

Samlesbury Playscheme Booking Form

Please note that this form is for Samlesbury scheme
For Leyland go to playscheme.org/book

Step 1 of 4

Parent/Guardian Details
Title
First Name
Surname
Address




Postcode
Home Phone
Daytime Phone
Mobile Phone
Email


How did you hear about the Playscheme?

Booking Details
Total Playscheme Places


Red fields MUST be completed Grey fields should be completed if possible