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Participant Information
Venue
*
Activity
*
Preferred Day/Time
Name
*
Relevant Medical Information (Include controlled medical conditions such as asthma)
Gender
M
F
*
Date of Birth
1950
1951
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*
Contact Information
Name
*
Mobile Number
*
Other Telephone Number
*
Other Contact Details
Home Address
*
Email Address
*
Membership No (if applicable)
I hereby release Sport for Life, its facilities providers, and any of their officers, sponsors, coaches and employees from any and all liability in any respect with regards to personal injury or accident or loss or damages to personal property whilst in attendance of these programs, and from any claims I may have on account of personal injury to myself or my child. I also to agree to Sport for Life's
Program Policy
.
Accept
