Hobbies Registration Form

    Name*

    Mobile Number *

    Email


    Emergency Contact

    Name*

    Contact details*


    Course choice 1:

    Course choice 2:

    Course choice 3:

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    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  


    Facebook  


    Previous learner  


    Received brochure/leaflet  


    Other  


    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: *



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