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Please fill out this very brief survey so that we may keep record of your participation in this and future session.

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* 1. Name

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* 2. Date of Birth

Date

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* 3. Postcode

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* 4. Preferred contact details (I.e. phone number, email address, etc)

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* 5. Emergency contact details (name, relation to you, phone number, etc)

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* 6. Name of session that you are attending:

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* 7. How did you hear about this session?

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* 8. For health & safety reasons, have you been diagnosed with any medical conditions that Palace For Life Foundation coaches should be made aware of?

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* 9. If you have answered "Yes" to the previous question, could you please elaborate on your condition. If you have answered "No", please write "N/A".

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* 10. Palace for Life Foundation will use the information that you have provided for monitoring & reporting purposes.

This information will be kept for a reasonable time as necessary to meet any funder or statutory requirements and to run, fund and evaluate our effectiveness as an organisation should you subsequently engage on activities with us.

For further information on our general data & information policy, please click here.

Please tick this box to confirm that you give your consent to provide this information and can confirm that it is correct to the best of your knowledge.

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