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Breathe Drop in Registration Form
Please register your details before attending for the first time.
Please complete the following form with your contact and emergency contact details.
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* Indicates required question
Email
*
Your email
Your phone number
*
Your answer
Full name of responsible adult
*
Your answer
Number of children attending
*
Your answer
Do you have any health conditions we would need to know about in an emergency?
*
Yes (if yes, please state details below)
No
Required
Details of health condition
Your answer
Emergency contact (name and phone number of someone to call in an emergency)
*
Your answer
Data privacy statement:
This information will not be shared with anyone without specific consent to share, and your contact information will only be used for administration purposes.
*
I understand and agree to the data privacy statement above
Required
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