A-MUSE: Stevenage Museum
Online Workshop Booking Form
Name of Main Applicant (over 18)
Address of Main Applicant including postcode
Contact Telephone Number of Main Applicant
Email Address of Main Applicant
Names and Ages of Additional Participants
Do you or any of the named participants have any access requirements or needs that we should be aware of so that they can participate fully in the project (such as physical or learning disability, visual or hearing impairment, injury, behavioural or medical conditions)? If yes, please provide details here:
Disclaimer Statement: By participating in BEEE Creative workshops online you must take full responsibility for your own and any child/ren safety. All sessions are undertaken at the participants' own risk. We cannot accept liability for damage to personal property caused whilst taking part in the sessions. You understand that to participate in the session you are responsible for your own and any child/ren health and must reduce or stop activity at any moment if you feel pain, or become unwell. On behalf of all the named applicants, do you agree to these terms and conditions? *
BEEE Creative CIO would like to send you information about future projects by email. Do you want to hear about other BEEE Creative projects?
Clear selection
BEEE Creative CIO would like to send you their latest information and updates on activities with a monthly newsletter distributed by Mailchimp. Do you want to receive the monthly newsletter?
Clear selection
Date signed:
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy