Hobbies Registration Form


Mobile Number *


Next of Kin


Contact details*

Course choice 1:

Course choice 2:

Course choice 3:

Course choice 4:

Do you wish to receive a monthly email/newsletter about our new courses?

If yes, please print email address clearly.

Where did you hear about us?

Recommended by a friend/family member  


Previous learner  

Received brochure/leaflet  


Learner Declaration

1. Do you have any medical or health issues that we need to be made aware of?

If yes, please give details:

2. Any specific learning needs that tutors need to be aware of?

If yes, please give details:

3. Photographs/digital images may be taken as part of class activities/Award ceremony and may be included in WCPM promotional materials, website, social media site and funding reports.
Please tick: I give my permission I do not give my permission

Data Protection Statement

The information collected on this form will be held by Women’s Community Projects (Mullingar) Association CLG (WCPM) in manual and/or electronic format in accordance with GDPR regulations
By registering, you confirm that you agree to the storing and processing of your data by WCPM.

Signature: *

Date: *