Course Registration Form

REGISTER

Welcome to Captivate – we are looking forward to working with you soon.  When you have completed your form, ensure you receive a text box confirming the form has been successfully submitted as soon as you press the SEND button.

Terms & Conditions

Your Full Name (*)

Your Email (*)

Your Phone Number (*)

Your Address and Postcode (*)

Your Date of Birth dd/mm/yyyy (*)

In Case of Emergency Contact (*)

Your Occupation

Course or Workshop Name (*)

Course Date (*)

Course Fee (*)

To register please inform us of any medical conditions, injuries or allergies; or if learning support is required (*)

Are there special instructions for us to support you with any condition listed above?

Please tell us your previous performance training or experience (please include dramatic combat draining if you are registering for a dramatic combat course) (*)

Do you train in any other sports or physical disciplines regularly? Please list (*)

How did you hear about us? (*)

Please type confirmation that you have read and understood our Course Terms and Conditions (link below). By clicking 'send' you agree to these terms and conditions (*)

Would you like to join our mailing list for updates on news, training and job opportunities?


Terms & Conditions

Thank you! You will receive an email reply shortly.  If you do not hear from us within 48 hours, check your junk mail, and then email info@captivate-action.com

Please let us know your preferred method of payment and we will forward you the relevant details.  We accept BACS, cheque, cash in person, and PayPal (additional fee applies).

Make sure you have read and understand our COURSE TERMS AND CONDITIONS.

DATA PROTECTION:

Under no circumstances will your information be passed to third parties.  Details such as date of birth, previous performance experience and any Medical History you provide may be shared with the tutors and directors who will directly be working with you.  Full details are in our DATA PROTECTION POLICY.

Any questions please get in touch

 

We look forward to working with you!

 

  • Photograph: Minna Paija, Fight Performer
  • Photographer: Ben Porter