Core Sentience

Consent & Disclaimer Form

By completing and signing this form, the attendee consents to Core Sentience processing personal data relating to the attendee for legal, personal, administrative, and management purposes and in particular to the processing of any special categories of personal data (as defined in the General Data Protection Regulations) relating to the attendee.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

Date of Birth

MM

DD

YYYY

Emergency Contact Details

First Name

Last Name

Emergency Contact Phone

(###)

###

####

Relationship

Name and Address of Doctors Surgery:

Please advise of any medical conditions and any current medication you may be taking:

Please advise of any physical conditions eg. back pain, shoulder, knee pain etc.

Please advise of any dietary requirements:

Please advise of any allergies:

Please let us know any other information you wish to disclose:

By checking this box, the attendee consents that Core Sentience bears no responsibility, nor liability, for any injuries suffered by the attendee, whether this is during the participation of the activities, or during the wider scope of the experience.