SAM IVIN

Which session do you want to attend? *

If the session is full you will be put on a waiting list.

10:00am, 4th April

11:30am, 4th April

Child Name *

First Name

Last Name

Child Date of Birth *

MM

DD

YYYY

Sex at Birth *

Male

Female

Prefer not to say

Parent or Guardian Name *

First Name

Last Name

Phone *

(###)

###

####

Do you want a copy of this form sent to your email address?

Yes

No

Privacy Policy (GDPR) *

Yes, I have read and agree with the Sam Ivin Photography Privacy Policy, with the storage and handling of my data by this website and related systems. Link to Policy at bottom of website.

Yes

Photograph Permission: I consent to Sam Ivin Photography, Rugby Museum & Art Gallery and partner organisations taking and publishing photographs and/or images of myself or child/children for the purpose of promoting or publicising this activity. *

Yes

No

Only if images are anonymous. Only if my child and myself are not identifiable.