Summer Camp Registration - Adult

If you wish to purchase a place at our 2020 Summer Camp, please complete the form below. Upon completion, we will contact you to set up a payment plan.

Film Camp Registration - Adult

Name of Attendee * First Last
Mobile 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 *
Name of emergency contact First Last
Emergency contact number *
Which areas are you most interested in? (Tick any that apply).
Acting and Improvising Camera, Lights & Sound Costume & Set Design Special Effects Makeup Writing, Directing & Producing
Medical Information
Name of GP * First Last
GP Contact Number *
Maximum of 18 characters allowed. Currently Entered: 0 characters.
In order for us to provide our highest quality care and support for you, we need to be informed of additional requirements.
Dietary requirements, for example: vegetarian, halaal, food allergies. If none, please write “none”. *
Medical requirements, for example: medications, adverse reaction to medication, eczema, asthma, diagnoses or ongoing investigations. If none, please write “none”. *
Social, emotional and mental health, for example: counseling, 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”. *
Any additional information, requirements or strategies you would like us to know. *
I give my consent for ACT 2 CAM to make film, photograph and audio recordings (herein called “Media”) of myself 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 myself 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 teachers, parents and 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 teachers, parents and 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

Summer Camp Registration - Adult

Film Camp Registration - Adult

Medical Information

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