JLS Course Application Course Selection Name TitleMrMrsMissRather Not Say Date of Birth: Address Contact Info Emergency Contact Medical History Are you Left or Right Handed?Left HandedRight Handed Do you have any medical conditions?NoYes [group MedicalConditions] Please provide details of any medical conditions below, be as descriptive as you can. [/group] Do you have any enhanced accessibility requirements or physical impairments?NoYes [group medical2] please provide details of any enhanced accessibility requirements or physical impairments below, be as descriptive as you can [/group] Do you have any specific requests of your archery beginner course coaching team?NoYes [group courserequest] Please provide details of any specific requests of your archery beginner course coaching team below, be as descriptive as you can [/group] Consent section Tick the boxes to agree with the statement Data use and retention - I consent to the Bowmen of Harrow Archery Club storing and retaining my data for use by Bowmen of Harrow in running their archery club and I understand that submission of this form does not automatically grant me a place on a beginners course. Photo, Video and Digital Content - I hereby grant Bowmen of Harrow permission to use my likeness in a photograph, video or other digital content reproduction in any and all of its publications, including but not limited to Social Media or website entries, without payment or any other consideration. Consent may be withdrawn at a future point in time by emailing secretary@bowmenofharrow.org.uk Physical contact - I acknowledge that the teaching of archery (like many sports) does involve some physical contact between coach and beginner and I am stating that I accept this. Survey section Do you have any archery experience?NoYes [group archeryexperiencegroup] Please provide details on your archery experience (i.e. Tried Archery at a "Have a Go" session) [/group] would you be interested in a future beginner course with Bowmen of Harrow?NoYes Confirmation Today's Date: Full Name: Digital Signature:
