Register Name First Last Date of birth Day Month Year Age 18+ Under 18 Name of adult First Last I am filling out this form in the name of the above person. My relationship to this minor is:relationship Contact infoPhone (home) Phone (mobile) Email Emergency contact First Last Emergency contact phone How did you hear about Fire House? HealthDo any of the following apply to you? Asthma Arthitis Diabetes Injury High blood pressure Osteoporosis Heart conditions Back pain Pregnancy or recently given birth Operation within last 12 months None of these apply to me Details*We advise that you seek approval to participate in exercise or dance classes, sessions or events from a GP or health official before taking part in dance or exercise.* Yes, I understand this advice Allergies or any other condition you think we should be aware ofHave you ever been told not to exercise by a professional? Yes, I have been told not to exercise No, I haven't been told not to exercise DetailsDisclaimerWe make every attempt to ensure our clients and their family/friends are safe when attending our classes/sessions and events, both at Fire House Studios and other venues. However, there is always risk involved when participating in or attending any activity or exercise, and participants do so at their own risk. We cannot be held liable for injury, illness or death to any persons or damage to/loss of any property while attending/participating in any class/session/event run by Fire House Dance or Siren Fitness. I confirm that I (or the client, if under 18) do not have illness, impediment or physical condition which would cause harm to me when participating in dance or other exercise. I have any doubts as to my fitness or safety to participate, I shall immediately withdraw. I have read and understand this disclaimer.Signature* Reset signature Signature locked. Reset to sign again Photo consentOccasionally we may take photos and videos during class or at related events which may be used for advertising purposes in the local press and online. At the discretion of Fire House Studios (Heather and Howard Bullock) they may be uploaded onto the Fire House Studios website, Facebook page and other appropriate sites. Children will not be names on any of these sites by Fire House Studios. It is not permitted in class (or other events) for parents or any other parties to take photos or videos at any time unless permission is previously arranged with Howard or Heather, To comply with the data protection act 1998 we ask for your permission to use these photos/videos as stated. Please sign to give your consent:Signature Reset signature Signature locked. Reset to sign again PoliciesData collection, processing and protection policy I have read and accept the policies at firehousestudios.uk/policies and agree for Fire House Studios/Siren Fitess/Fire House Dance to collect, process and store mu data (and, if applicable, that of the child I am responsible for) in line with the policies Signature* Reset signature Signature locked. Reset to sign again
