Candy & Chrome Booking Form

Candy & Chrome Booking Form

Physical Activity Readiness Questionnaire (PAR-Q), Informed consent, GDPR, Media usage AND booking form. Fill out the form carefully for registration.
Please fill in this form prior to a Free Taster session, Workshop, Beginner course, Or each time you move up a level.
Student Name*

First NameMiddle NameLast Name
Student E-mail*
Please provide the email address that you actively check and receive mail to. By providing these details, you are agreeing to email correspondence from us directly, concerning your class bookings, but not signing up to our email newsletters. You have the choice to sign up to our newsletter separately. We do not share your details with third parties.
Yes, subscribe me to this newsletter.No thanks
Mobile Number*
By providing these details, you are agreeing to contact from us directly via call or text message, and only when it concerns your class bookings. We do not currently send marketing texts or calls. We do not share your details with third parties.
We generally send emails once or twice a month and find it is the best way to keep you informed of your latest course start dates & times, and changes to your classes, special offers, exciting events & more! Classes are limited in numbers so it's best to be well informed so you can book early to avoid disappointment.
Class Type:*
Date of class or course start date*

DayMonthYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
We need to take this for legal reasons only. We do not send you post.
CONTACT - How and why we contact you & data storage info:

Candy & Chrome do not provide a company telephone number, as email and social media messaging are our preferred method of maintaining important, relevant and reasonable contact with you. Candy & Chrome are legally required to store information provided, and do so under strict GDPR compliant guidelines, which can be found on the website - www.candy-chrome.co.uk, along with our FAQ'S, rules and T&C's. The contact information supplied will be used to send email notifications, no more than once a week (but usually less). Emails contain an opt-out option with each notification. You may also on occasion be contacted via SMS, Whatsapp or phone call, but usually only in case of urgency. Contact details of 'Next of kin' are only used in case of an emergency. We do not send anything via postal mail to your provided address ever, unless specifically requested. Candy & Chrome do not share personal details with any third parties without your consent, ever. However we do use third parties to temporarily store information securely, as this is the safest option to process your information. Candy & Chrome may send you friend requests via social media, we take your acceptance of this as acceptance of contact or notifications via social media. Candy & Chrome respects your privacy, and aims to keep marketing to an absolute minimum.
I have read, understood, and accept contact from Candy & Chrome
Students Age:*
We accept students age 16-17 WITH parental consent. You must be age 18 or over to participate WITHOUT parental consent.
I am aged over 18 - No parental consent requiredI am age 16-17, and I have consent. I give Candy & Chrome permission to contact the parent/guardian that I have named below.
Name of Parent/Guardian

First NameLast Name
Contact Mobile Number
Please make sure your Parent/Guardian is aware and expecting this call.
Next Of Kin Name*

First NameLast Name
Next Of Kin Contact Mobile Number*
All participants must provide a next of kin, who can be contacted in the case of a medical emergency.
Medical Questionnaire

For legal reasons, as well as your safety, we must ask you some basic medical questions.

Please give details of any medications you may be taking (including dosage), medical conditions that may be affected by exercise, recent surgery details, details of medical conditions, ailments, GP advisories or even just other information you feel we should know about.

You can do this using the medical notes, at the bottom of this section.
Yes (Please include details in the medical notes below)No
Yes (Please include details in the medical notes below)No
Yes (Please include details in the medical notes below)No
Yes (Please include details in the medical notes below)No
Yes (Please note, pregnant ladies and brand new Mums are not permitted to participate)No
NoneHigh/Low Blood PressureMigraine/Chronic HeadachesHeart Disease/AttackDizziness/FaintingPeri/Post MenopauseChest PainArthritisEpilepsyDiabetesOther Conditions (Including mental conditions)
Medical Notes:
MEDICAL RELEASE

I know of no physical or medical condition which I, or my doctor feel could be aggravated by my using of the equipment and participating in activities sponsored by Candy & Chrome. I agree to advise Candy & Chrome in writing if any of the above information changes, or if my doctor advises me to stop, reduce or otherwise adjust my exercise regimen. I will advise my instructor immediately if I injure myself in any way during a session. The above information given on this form is, to the best of my knowledge, complete and accurate. I have read, understood and accept the Terms & Conditions, FAQ's and Rules outlined on the Candy & Chrome website. I understand that the information supplied will be treated with the utmost confidence, and my participation in the activities lead by Candy & Chrome will be undertaken at my own risk. I am satisfied that I have been informed by Candy & Chrome of the potential risks involved, and participate of my own free will.
I have read, understood, and accept the above
INJURY - General

Pole dance & fitness is a fantastic whole body work out, however most people find that it takes a couple of weekd for the body to adapt to supporting weight on parts of the body that ordinarily wouldn't be weight baring. Therefore post activity aching can occur. Bruising or chafing may also occur, but just like how your feet adapt to a new pair of shoes, your body will become accustomed to it. During and after your session, you will most likely feel uncomfortable or achy. The sessions will be strenuous and place new kinds of discomfort on your body in places but NOTHING you do should cause acute, serious pain. If you experience this, you must safely stop what you are doing and inform your instructor.
I have read, understood, and accept the above
FITNESS - General

Pole dance & Fitness can be very physically strenuous. It is unsuitable for people who suffer from back or neck problems. Some minor ailments such as occasional joint problems or old injuries may be able to be worked around, however it is mandatory that anything of relevance be clearly stated on arrival.
I have read, understood, and accept the above
MEDIA - General

I understand all moves, routines, teaching techniques demonstrated to me during the session remain property of Candy & Chrome. My participation in a Candy & Chrome session does not give me authorization to replicate any routines or moves learnt in this session to other participants in any context. Photography and video footage taken during the session by any participants remain the property of Candy & Chrome, and unless otherwise stated, I give full authorization for Candy & Chrome to use my face on any footage taken during the session in any publicity or marketing campaigns in the future. I understand that Candy & Chrome give me permission to take photo's and video's of myself during class time for personal use and social media, however I also understand that I am strictly not permitted to include anyone else in these images or footage as I do not have the relevant permissions to do so. I also understand that I am not permitted to record full class and course content and may be asked to leave without refund if I do not respect the rules outlined on the Candy & Chrome website.
I have read, understood, and accept the above
I confirm that I have read, understood, and accept the T&C's, FAQ's & Rules, outlined on the Candy & Chrome website
Signature*

Clear
Today's Date*

DayMonthYear
Date
Please verify that you are human*
Should be Empty:

Candy & Chrome Booking Form

Please fill in this form prior to a Free Taster session, Workshop, Beginner course, Or each time you move up a level.

CONTACT - How and why we contact you & data storage info:

Medical Questionnaire

MEDICAL RELEASE

INJURY - General

FITNESS - General

MEDIA - General