Dance For Parkinsons - Registration Form (Online)

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Dance For Parkinsons Form

Name of participant

Emergency Contact Name *

Emergency Contact Number

Second Emergency Contact Name

Second Emergency Contact Number

Any access requirements? *

Any medical information that we need to be aware of? (Including allergies) *

Date completed this form:

YYYY

Email Address (this will be used a primary mode of communication)

Do you consent to weekly recordings being available to yourself and other members of the group? (You can review your consent at any point by emailing takepart@theatrclwyd.com)

Yes

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Declaration: I understand that you will use the information provided above for communication purposes in relation to this Project and for support and welfare. I declare that the information I have given on this form is correct and complete. Theatr Clwyd is a ‘data controller,’ this means we’re responsible for making sure your personal data is secure and used in an appropriate way. We will use the data you provide to ensure we communicate with you any activities/issues relating to our workshops and for welfare purposes. We will not share your data. For more information and to read our privacy policy please visit: www.theatrclwyd.com/en/privacy-policy.Rwyf yn deall y byddwch yn defnyddio’r wybodaeth yr wyf wedi’i rhoi uchod at bwrpas cyfathrebu mewn perthynas ar Brosiect yma ac ar gyfer diogelu a lles. Rwyf yn datgan bod y wybodaeth yr wyf wedi’i rhoi ar y ffurflen hon yn gywir ac yn gyflawn. Theatr Clwyd, yn 'rheolydd data'. Mae hyn yn golygu ein bod yn gyfrifol am wneud yn siŵr bod eich data personol yn ddiogel ac yn cael eu defnyddio mewn ffordd briodol. Byddwn yn defnyddio'r data rydych yn eu darparu i sicrhau bod y gwasanaeth a gynigir yn cael ei ddarparu. Ni fyddwn yn rhannu eich data. Am fwy o wybodaeth ac i ddarllen ein polisi preifatrwydd, ewch i: www.theatrclwyd.com/en/privacy-policy.

YES

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