RAINBOWS – BHPT

Rainbows Over Burnham

Please ensure the person filling in this form is over 18.

First Name

Last Name

House Number and Street

Town

Postcode

Telephone Number

Gender

Male

Female

Prefer not to say

Date of Birth

Parent / Guardian Name

First Line of Address

Postcode

Childs School

Childs Name

Childs Date of Birth

In accordance with the Data Protection Act 2018 Burnham Health Promotion Trust need your permission to obtain and hold information about you. By signing this form you are consenting to us obtaining and holding this information, which we will not share with any other company /organisation unless legally required to do so. You may ask for your data to be removed from our records at any time by emailing us at info@bhpt.org.uk or by writing to the Chief Officer at BHPT, Minniecroft Road, Burnham, Bucks, SL1 7DE. Full details of our Privacy & Data Protection policy are available to view on our website.

I further give my permission for BHPT to contact with me about this initiative and to use the information given to anonymously monitor services, to help us provide the best range of services in Burnham and to allow BHPT to advise me about new services or activities that they are offering and their newsletter. Furthermore, I give my permission for BHPT to use our names and pictures of our submitted images for marketing and advertising purposes.

I consent to my child entering this competition

YES

Please remember to press PRINT before you submit if you would like a hard copy of this form..