Cookery Expression of Interest

Personal Information

1. First Name

2. Surname

3. Date of Birth

4. Address

5. Postcode

6. Contact Tel No

7. Email Address

Emergency Contact Details

8. Full Name

9. Relationship

10. Phone Number

Health & Dietary Requirements

11. Do you have any allergies, intolerances or dietary requirements
YesNo

12. If yes, please provide details:

13. Do you have any medical conditions or support needs we should be aware of (e.g. mobility, medications etc.)?
YesNo

14. If yes, please provide details:

Photography and Media Consent

15. We may take photos during the class for promotional purposes (social media, website, flyers). Do you consent to having your photo taken?
YesNo

The Data Protection Act 1998
The data collected on this form will only be used to administer your application for cookery classes. The information will not be used for any other purpose unless you have given your express consent.

Cookery Expression of Interest

Personal Information

Emergency Contact Details

Health & Dietary Requirements

Photography and Media Consent

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