Hobbies Registration Form

Name*

Contact details *


Next of Kin

Name*

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?   Yes   No

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?   Yes   No

If yes, please give details:


2. Any specific learning needs that tutors need to be aware of?   Yes   No


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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