Customer Data and Feedback Form

We have decided to use a data base to advise our customers of forth coming events and offers, please fill in the data capture form to assist us to reward you.

Your name:
Your Address:
Your email address:
Your telephone number:
Your mobile number:

Child's name:		Child's Date of Birth:
Child's name:		Child's Date of Birth:
Child's name:		Child's Date of Birth:
Child's name:		Child's Date of Birth:
Child's name:		Child's Date of Birth:

How often you visit Little Acorns?:	1-2 times per month 2-5 times per month More than 5 times per month
Have you held a party for your child:	Yes No
Have you attended a party at Little Acorns?:	Yes No
Do you own/work at a local business?:	Yes I own a local business Yes I work at a local business No
If you answered yes above, please enter the business details here:
Business Email Address:
Where did you hear about us?:
Any feedback is welcome from our customers. Please use this comments box, good or bad:

©Worcester Children's Indoor Play Limited t/a Little Acorns - Registered in England: 6449711
Registered Address: Unit 2A, Everoak Industrial Estate, Bromyard Road, St Johns, Worcester. WR2 5HP
VAT No: 924292326
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