Mr / Mrs / Ms / Miss:______________________________________________________
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Surname:________________________________________________________
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Given Name:______________________________________________________________
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Address:________________________________________________________________
________________________________________________________________________
_____________________________________Post Code:_________________________
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Birthdate: D(_____) M(_____) Y(_________)_______________________________
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Telephone
Numbers: |
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Home: (___)_____________________________________________ |
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Business: (___)___________________________________________ |
E-Mail Address:___________________________________________________________ |
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Occupation:______________________________________________________________
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I wish to undertake the beginners course in archery with KuRingGai
Bowmen Inc. I understand that the current cost of a beginners course
is $60.00 and agree to payment in full before the start of the course.
I will abide by all of the safety instructions that will be given
to me during the running of the course. |
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Signed:__________________________________________________________________
Date:____________________________________________________________________
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If the applicant is a junior (ie. under 18 years of age) we require
a Parent or Guardian's authorisation:
Parent/Guardians Name:_____________________________________________
Signature:________________________________________________________
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Note: If the applicant is under 12 years of age we require
a Parent or Guardian to be in attendance at all times.
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Optional and confidential: To help us to prepare for any possible
medical emergency, do you have a medical condition that you feel
we should know about or that may or may not effect your physical
abilities:
________________________________________________________________________
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