Hobbies Registration Form


    Mobile Number *


    Emergency Contact


    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: *

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