House of Trixie Blue Enrolment Form
It is more than a pleasure to sign you up to our 2019 courses.
Please fill in the below before the start date of your course to ensure a smooth enrolment.
Love & Shimmies,
House of Trixie Blue
x x x
In accordance with the GDPR, I’d like to inform you that your information will not be shared with any third party, unless you request for me to do so.
Date of Birth
Do you celebrate your birthday?
Would you like to be added to the class Facebook group?
Next of Kin Name
Next of Kin Contact Number
Known Medical Conditions
Accident Waiver and Release of Liability Form
Please read in full and tick a checkbox below:
In accordance with GDPR, House of Trixie Blue DO NOT and WILL NOT share any of your personal information/data to a third party. You can request your details to be removed from our database at any time.
I hereby wave and release any and all claims whether for personal injury, property damage, damages, losses and/or death that may arise from my participation in House of Trixie Blue’s events/classes/workshops/film & photoshoots.
I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this activity or event.
I accept the risks and agree to use my best judgment to abide by all safety instructions given by House of Trixie Blue.
INTELLECTUAL PROPERTY RIGHTS - The following will remain the property of House of Trixie Blue, including choreography, marketing, logo, lesson concepts and costume designs unless otherwise agreed in writing with House of Trixie Blue directly.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity or event.
This waiver of liability and assumption of risk is effective from the aforementioned date and is valid up until the completion of the agree activity undertaken with House of Trixie Blue and it may not be amended without prior written consent.
I understand that at this event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by House of Trixie Blue.
I CERTIFY THAT I HAVE READ THIS DOCUMENT, AND I FULLY UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT OF MY OWN FREE WILL.
Accident Waiver and Release of Liability Form Acceptance
Yes I agree
No I do not agree
Send me a copy of my responses.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service