Gravesend Goddesses medical assessment and media consent form

First name

Last name

Date of Birth (18+ only)

Day

Month

Year

Only those over the age of 18 may participate in this workshop

Phone

Email

Multi-line address

Country/Region

Address

City

Zip / Postal code

Any other conditions, investigations or procedures to disclose

Emergency contact and phone number

I understand that should i have any medical conditions that i will need to bring necessary medications with me. eg. inhalers, time critical meds, epipens

I understand that any time i do not follow the instructor's guidance, i do so at my own risk.

I understand that should i not make the instructor aware on booking or in advance before on the form, or before start of class, they are not liable for any possible injury or worsening of condition

I understand that photos and videos may be taken within the class sessions and posted online for promotional and advertising purposes. Any attempt to pass these routines off as my own or posting longer than 60 seconds is a copyright infringement; resulting in expulsion from the class and possible fines.

Consent for online videos and images for website and social media

I do NOT consent for photos or videos to be taken of me

I DO consent for photos and videos to be taken of me, but only used on private social pages

I DO consent for videos and photos to be taken of me and used publicly

Should you choose to redact your consent at a later date after images and videos posted publicly, it will not be possible to remove as it would affect others' wishes and preferences. But your changed preference will be upheld for all future posts.

I understand that should i need to cancel my spot or not show up, i will not be able to receive a refund. This is due to the efforts made for venue hire, instructors time, and provision of equipment.

Any queries to this would only be in exceptional circumstances

Date

Day

Month

Year

Signature

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Pre-assessment Forms

Gravesend Goddesses medical assessment and media consent form