ADULT CLASS ENROLMENT

Please complete the form below to enrol. Adult classes are free to attend, with optional extras such our end-of-year shoot, which you can pay to take part in. Ask a member of staff for details.

Term Time Registration Form - Adult

Name of Attendee * First Last
Mobile Number *
Maximum of 18 characters allowed. Currently Entered: 0 characters.
Alternative Number *
Maximum of 18 characters allowed. Currently Entered: 0 characters.
Email Address *
Home Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Date of Birth * / DD / MM YYYY
Sex *
Which class will you be attending? *
Name of Emergency Contact * First Last
Emergency Contact Number *
Maximum of 18 characters allowed. Currently Entered: 0 characters.
Medical requirements, for example: medications, diagnoses or ongoing investigations. If none, please write “none”. *
Social, emotional and mental health for example: counselling, behaviour management, history of anxiety or self harm. If none, please write “none”. *
Accessibility requirements, for example: wheelchair access, assistive devices or specific materials. If none, please write “none”. *
Allergies, for example: eczema, hay fever, food allergies or adverse reaction to medication. If none, please write “none”. *
I give my consent for ACT 2 CAM to make film, photograph and audio recordings (herein called “Media”) of me at appropriate times, during my participation in the ACT 2 CAM course. *

I give my consent for ACT 2 CAM to make film, photograph and audio recordings (herein called “Media”) of me at appropriate times, during my participation in the ACT 2 CAM course. I consent I do NOT consent
I give my consent for ACT 2 CAM to exhibit at organised events and exhibitions, and to distribute the edited Media to other students on the course. *

I give my consent for ACT 2 CAM to exhibit at organised events and exhibitions, and to distribute the edited Media to other students on the course. I consent I do NOT consent
I give my consent for ACT 2 CAM representatives to use the Media, on promotional materials, social media, press releases, and the ACT 2 CAM website, as they see fit. *

I give my consent for ACT 2 CAM representatives to use the Media, on promotional materials, social media, press releases, and the ACT 2 CAM website, as they see fit. I consent I do NOT consent
I give my consent for ACT 2 CAM to store this information, and contact me, in accordance with UK General Data Protection Regulation (GDPR) law, 2018. *

I give my consent for ACT 2 CAM to store this information, and contact me, in accordance with UK General Data Protection Regulation (GDPR) law, 2018. I consent I do NOT consent
I have read and understood ACT 2 CAM’s Terms & Conditions *
Agreed
I have read and understood ACT 2 CAM’s Code of Conduct *
Agreed
I have read and understood ACT 2 CAM’s Privacy Policy *
Agreed
How did you hear about us? *

How did you hear about us? Existing member Internet search School Word of mouth Employer Advert Facebook Twitter Instagram Other Other
This document contains the full and complete understanding between myself and ACT 2 CAM. It supersedes all prior understandings and agreements between us and cannot be modified except by written agreement.
Draw your signature into the box below. *

Clear
Date of signing * / DD / MM YYYY
Notes

Whitley Bay Big Local,
158 Whitley Road,
Whitley Bay,
Newcastle, NE26 2LY
Find Us
+44 7973 869477

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ADULT CLASS ENROLMENT

Term Time Registration Form - Adult

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