Application for a body treatment registration

Name of applicant
I/We make application for registration to carry out the following activities at the premises detailed below
AccupunctureTattooingSemi-permanent skin colouringCosmetic piercingElectrolysis
Type of registration
Applicant details
Title
First name(s)
Surname
Date of birth
Home address
Post code
Telephone number
Mobile number
Email address
Are there any additional persons to be registered
YesNo
Details of premises
Details of premises (trading name)
Address of premises
Post code
Telephone number
Mobile number
Email address
Vehicle registration (if mobile)
Description of premises

Include the number of rooms, arrangements for the cleansing of premises, fittings, equipment and the sterilisation of instruments

Has anyone named in this application been previously registered by any other authority?
YesNo
If yes, please give details
Has anyone named in this application ever been convicted of any offence under Sections 14/15 Local Government (Miscellaneous Provisions) Act 1982?
YesNo
If yes, please give details
I understand that the information I have provided, will be held by the council on both computerised and manual files. This data may be made available on a public register if so required by relevant legislation. The data may also be disclosed to other departments within the council and other organisations, but only in order to ensure compliance with relevant legislation, for identification purposes or to prevent or detect fraud or a crime.
I will notify Blackpool Council of any change of address
I agree
Name

First name

Last name
Date
Name

First name

Last name
Date
Name

First name

Last name
Date
Name

First name

Last name
Date

Acupuncture/tattooing/semi-permanent skin-colouring/cosmetic piercing/electrolysis registration