Registration form- Adults

Name: *

First

Last

Date of birth:

Address:

Class or event attending:

Fitsteps
The Art Social
Expressions Academy class

How did you find out about us?

Phone number:

Email address: *

Medical details:

Emergency contact name *

First

Last

Emergency contact phone number:

Do you consent to your data being added to our database for communication purposes, eg information about future events and newsletters:

Yes
No

If Yes, please circle how we can communicate with you:

Email
Text message
Phone call

Do you consent to your data being added to our database so we can use your details at future events (and prevents the need for additional forms to be completed)

Yes
No

Do you give permission for Expressions Academy to record and use video footage or photographic images of yourself for website, social media and future advertising.

I do give permission
I do NOT give permission

Date of form completed and submitted:

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