Student's Name *
Student's Name
Parent or Guardian's Name *
Parent or Guardian's Name
Parent or Guardian's Mobile Number *
Parent or Guardian's Mobile Number
Parent or Guardian's home number
Parent or Guardian's home number
Student's Date of Birth *
Student's Date of Birth
Student's Mobile Number (if applicable)
Student's Mobile Number (if applicable)
Student's Address *
Student's Address
Release Form *
Photographs and/or video and/or audio recordings and/or interviews may be made during the course/workshop and may feature the students. These may be used for marketing or training purposes. This may include, but is not limited to, demonstrating the course and the fun the students are having in magazines, brochures, newspaper articles, videos, websites and other electronic media. By ticking the box below, you are granting permission for yourself or your child to be photographed/videoed/interviewed on behalf of Laurelle Wishart (or associates) and give permission for the intended uses as stated above. You also agree to release Laurelle Wishart from any and all liability associated with the use by Laurelle Wishart, or a third party, of the photographs/audio/video/interview as set out by this agreement. (Please note that we will happily take down an image of you/your child if you request this of us).
Waiver and Indemnity *
As the parent/guardian, I acknowledge that Laurelle Wishart is sharing a range of information, facts, research and opinions with the students that is not intended to be taken as personal medical advice. I hereby release, discharge and/or otherwise indemnify and hold harmless Laurelle Wishart, her affiliated organisations and sponsors, volunteers, their contractors and associated personnel, including the owners of venues and facilities utilised for related courses or workshops, from all liability for any loss, damage, cost or expense suffered by the student as a consequence of her participation in this course, including in the unlikely event of death or personal injury.
Cancellation Policy *
Laurelle Wishart reserves the right to cancel or change the course/event in any way at any time. In this instance, we will endeavour to provide you with as much notice as possible. In the event of the course being cancelled by Laurelle Wishart, a transfer will be issued for a future event or a refund issued, whichever you prefer. If circumstances change and the student cannot make the event, the enrolment may be transferred to another person or the student may transfer to a future course. No refund will be issued.
Student Expectations *
We pride ourselves on creating a nurturing environment where each student feels that they can be themselves and get the most of of this course. To this end, we have a zero tolerance policy for bullying and will not hesitate to expel a student from any course if their behaviour is inappropriate. We also expect each student to put in 100% effort during the course in order to get the best possible results.
How did you hear about this Course?
If a friend told you about us, please let us know their name so we can thank them 🙂