Taylor Payment Page | Happy Cactus

Participant First name

Participant Last name

Participant date of birth

Does participant have any underlying medical conditions that could prevent them from safely taking part

Yes - please provide details below

No

Please detail any medical conditions or other needs you feel we may need to be aware of for this participant

Contact Email

Phone

Emergency Contact Name for participant

Emergency Contact relationship to participant

Emergency Contact Phone for participant

I consent to Happy Cactus Coaching storing my information in accordance with their data protection policy.

I am happy to be contacted by Happy Cactus Coaching via email about other related events and activity.

Photo and Video consent for participant

Yes

No

Happy Cactus Coaching Co.
5 Harley Court
Stockton-on-Tees
TS18 3TT
happycactuscoaching@outlook.com