JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
MDI Registration & Monitoring Form
All information is held in accordance with the Data Protection Act 2018 & GDPR Regulations
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Telephone Number
*
Your answer
Address
*
Your answer
Emergency Contact (Name)
*
Your answer
Emergency Contact (Tel)
*
Your answer
Do you have any health conditions or previous injuries that your instructor / teacher should be aware of?
*
YES
NO
If YES, please give details
Your answer
Can MDI contact you about changes to a class?
*
YES
NO
Would you like to be added to the MDI Mailing List
*
YES
NO
I'm already on it
By checking this box you agree that you are responsible for your own health and safety in a class, and by following safe practice as demonstrated by the teacher risk of injury will be kept to a minimum.
*
I agree
Required
By checking this box you understand that classes may be filmed or photographed for promotional or archival purposes, and that you will let your teacher know if you do not consent to this. Any material created remains the copyright of MDI.
*
I agree
Required
Which of the following best describes your gender:
*
Male
Female
Intersex
Non-Binary
Other
Prefer not to say
What is your sexual orientation:
*
Heterosexual / Straight
Gay / Lesbian
Bi / Bisexual
Other
Prefer not to say
How would you describe your ethnicity:
*
White
Asian / British Asian
Black / British Black
Chinese
Mixed or Dual heritage
Other ethnic group
Prefer not to say
What is your age:
*
Under 16
16-19
20-29
30-39
40-49
50-59
60+
Do you identify as a D/deaf or disabled person or have a long-term health condition?
*
YES
NO
Prefer not to say
Where did you hear about MDI
*
MDI Website
MDI Social Media
Other online
Word of mouth
Other
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of mdi.org.uk.
Report Abuse
Forms
