Personal and Emergency Details

Personal and Emergency Contact Details

New Clients:

Please complete this form before completing your booking.

Important Note:

Emergency Contact information will be used in case of emergency only. Please refer to the Confidentiality and Privacy terms in the Agreement for further information.

Please contact support@katienicholson.co if you have any questions regarding this form.

Client Name

First Name

Last Name

Client Email

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Residential Address

If different to Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Contact Person’s Relationship to You

eg. Partner/Spouse, Sister, Friend

Contact Person's Phone

Include Country Code + Area Code

Does this person live at the same address as you?