CL&AG - Adults Registration Form - General programs

Full Name*

Contact Phone Number*

Email Address*

I am registering for the following event/program:*

OPTIONAL QUESTION: I give permission to contact me about similar events/programs at Carnarvon Library & Art Gallery.

YesNo

OPTIONAL QUESTION: Do you have any dietary preferences we should be aware of? (eg Gluten Free, Lactose Free, Vegan, etc)

OPTIONAL QUESTION: Do you have any medical conditions we should be aware of? (e.g. allergies, epilepsy, diabetes, limited mobility etc.)

OPTIONAL QUESTION: Photo Consent - I give consent for images to be taken and for these images to be used, modified, and distributed by the Shire of Carnarvon.

YesNo