Fit Mama Group Consent Form
Consent form for participation in the Fit Mama fitness group at Hauraki Māori Trust Board. Sessions run every Monday, 12:30–1:30 pm. Please complete the form to confirm your participation and consent to information storage.
Full Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Will you be bringing any children or babies with you to the sessions?
Yes
No
Next of kin/ Emergency contact
Please contact Ashlee on 0211864067 with any questions or queries
I consent to any photos or videos taken of myself or tamariki/ babies to be used for promotional purposes
Yes
No
Submit Consent
Should be Empty: