enquiry form

bibic
Knowle Hall, Bridgwater, Somerset, TA7 8PJ
Tel: 01278 684060 Fax: 01278 685573

Registered Charity No1057635

Enquiry form

Please fill in this form telling us what information you would like to receive.

Name
Address
Email address
Daytime tel no
Please tick what sort of information you would like to receive from us:
Family information pack
Information about seminars or training
I have a child with a learning difficulty and would like some information about how BIBIC may be able to help
Child's name
Age
Diagnosis if known
Please tell us a little about your childs difficulties so we can make sure that we are sending you the right information.
If you are a professional working with children who have learning difficulties, please tell us what your area of interest is and your profession so that we can ensure that we send relevant information
A legacy pack
Information about volunteering
Fundraising pack
I would like to do a fundraising activity for you:
Run Swim Ball Abseil Other
If other please tell us about it here:
How did you first hear about Bibic?
Please enter the 5 digit verification code shown below: *