Crystal Competition Entry Form

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Please complete this form if you would like to participate in My Aerial Home's Crystal Competition.

Participant Name (First & Last) *

Email *

What is your regular MAH class? *

Are you entering as an adult or child? *

Adult

Child

Have you paid your entry fee of £10 to Macmillan via our Just Giving page?
*

Yes

Please pay here before submitting this form: https://www.justgiving.com/fundraising/myaerialhome?utm_source=copyLink&utm_medium=fundraising&utm_content=myaerialhome&utm_campaign=pfp-share&utm_term=d1c5ac10e1734e18ba0a300bd103c99c

Required

Are you happy to be photographed for marketing purposes?
*

Yes

Required

As a condition of my enrolment I accept full and complete responsibility for me own participation in the workshop. I acknowledge My Aerial Home's recommendation that I obtain a doctor's approval before my participation. I agree to hold Amanda Miles and My Aerial Home's coaches free and harmless of any and all liability for any death, subsequent injury or health problems that may result from or be aggravated by my participating in this programme. I realise that Amanda Miles and My Aerial Home and its representatives are only responsible for the coaching I have paid to participate in.
*

Yes

Required

If entering as a child, please submit the form now. If entering as an adult, please move on to Section 2.

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