Registration Form
2020 Registration for South Metro Media Program
Email address *
Full Name (Legal Name) *
Your answer
Phone number (Your mobile number if you have one/ or parent/guardian) *
Your answer
Suburb & Postcode *
Your answer
Address *
Your answer
D/O/B *
Your answer
Age *
Your answer
If Under the AGE of 18 - Do you have parent/guardian permission to register in this program *
Parent/Guardian Contact Details or Emergency Contact if 18+ (Full name and contact number) *
Your answer
Do You have any Know Allergies? If Yes details please! *
Your answer
I give consent for photos/videos to be taken and used for promotional purposes including online promotion. ie) Facebook, Instagram *
Ethnic Background if known
Your answer
Do you have any personal Equipment that you can utilise for your personal use in the program. ie: camera, software
Your answer
Which position would you like to focus on during this program. (Select more than one if you like) *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Foundation to Wellness. Report Abuse