Local Residents Autumn Pottery Group

Local Resident Autumn Pottery Group
Please note: This course is now fully booked. Any submissions will automatically be added to a cancellation list and your interest will be noted.

This Autumn Pottery group is for residents within 5 miles of Crickhowell. If you live outside of this area, feel free to submit this form and we will note your interest in attending.
The sessions will run 6pm - 8pm, on the following dates:

Thursday 29th September

Thursday 6th October

Thursday 13th October

Thursday 20th October

Thursday 27th October

Thursday 3rd November

Thursday 10th November

Thursday 17th November
First NameLast Name
Email
example@example.com
Do you live in a 5 miles radius of Crickhowell?

YesNo
Date of Birth*

MonthDayYear
Pronouns
Address

Street Address

Street Address Line 2

Town/City

Post Code
Are you able to attend all sessions? If not please state which dates will be missed.
Why does attending the local resident autumn pottery group appeal to you?
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Does the participant have any allergies, dietary requirements, or medical conditions that we should be aware of? If there are any measures we can take to support the participants engagement of the programme, please state below.
Travel bursaries are available to help with the cost of fuel or public transport where needed. Please state whether this is required, for more details or to discuss your needs please email, lucy@peak.cymru

Yes a travel bursary would be necessaryNo
Signature

Clear
The above details will be held and processed by Peak on computer. The forms will be kept by Peak for the promotion of our activities. Information will not be passed onto a third party without permission. Store and treatment of data are in line with GDPR regulations and our Privacy Policy which can be accessed on our website. https://www.peakcymru.org/fees-policies-resources

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Bydd y manylion uchod yn cael eu cadw a'u prosesu gan Peak ar gyfrifiadur. Bydd y ffurflenni'n cael eu cadw gan Peak er mwyn hyrwyddo ein gweithgareddau. Ni chaiff gwybodaeth ei basio i drydydd parti heb ganiatâd. Mae'r broses o storio a thrin data yn unol â rheoliadau GDPR a'n Polisi Preifatrwydd y gellir cael mynediad ato ar ein gwefan. https://www.peakcymru.org/fees-policies-resources
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Local Resident Autumn Pottery Group

Please note: This course is now fully booked. Any submissions will automatically be added to a cancellation list and your interest will be noted.