Brine Leas School External Service - Brine Leas School External Service

EVENING CLASSES ENROLMENT FORM

First Name:^*

Surname:^*

Date of Birth: (If under 20)

Address Line 1:^*

Address Line 2:

City:^*

County:^*

Postcode:^*

Home Telephone:

Mobile Telephone:^*

CAR REGISTRATION:

For the safety of all, please use the well lit car park at the rear of the building.

May we use the above details to contact you about further courses?

Yes
No

HEALTH - Please list any health issues of which we need to be aware.

e,g Severe asthma, epilepsy, diabetes, impaired mobility, hearing loss, visual impairment, dyslexia, other

Email Address^*

This will be your username and will be required when you log in to Wisepay.

Confirm Email Address^*

Please confirm your email address to ensure it has been entered correctly.

Password

##########

WisePay will automatically generate a strong password when this form is submitted. You will be sent an email to the email address entered above containing your log in credentials.

This challenge is to prevent automated systems from using this feature maliciously.
Load New Code

Print Name:^*

Protection of Personal Data and GDPR legislation

Brine Leas School External Service may ask you to provide personal data on this form. This data is stored by WisePay on behalf of Brine Leas School External Service, to meet the legal obligations of a contract between WisePay and Brine Leas School External Service. You are required to give your consent that this data can be processed by Brine Leas School External Service.

Your Consent

I consent that this data can be processed by Brine Leas School External Service.

Please ensure all consent / agreement fields have been accepted.

Welcome to our Online Payment Area

Welcome to our Online Payment Area