Please provide the following information to join us at Streams.
Once you've completed this, you'll be directed to our secure payment page to secure your place.
Please wait to be redirected after clicking the ‘Secure’ button at the end of this page.

Please note: payment is for the series (three sessions), and is not based on weekly attendance. Refunds are not available.

Name of Participant

First Name

Last Name

Age of Participant

Pronouns

Emergency Contact Phone

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Emergency Contact Name

First Name

Last Name

Your Email Address

Address

Address 1

Address 2

City

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Zip/Postal Code

Country

Medical and Access

Please tell us of any allergies, medical or access you have

Media Consent

87 Gallery asks participants for their consent in regards to representation. Streams will utilise digital processes including video, audio, and photography. These recordings will be used on 87 Gallery and The Critical Fish's channels to share our experiences, and to document the outcomes of the sessions. Please select indicate below if you agree to your image being used as described above.

Yes, I consent

No, I do not consent

Please indicate a confidence level in sharing your work and ideas

Voluntary Information: Do you consider yourself to have a disability?

Voluntary Information: How would you describe your ethnicity?

Voluntary Information: How would you describe your gender?