Mr / Mrs / Ms / Miss:______________________________________________________
Surname:________________________________________________________
Given Name:______________________________________________________________
Address:________________________________________________________________
________________________________________________________________________
_____________________________________Post Code:_________________________
Birthdate: D(_____) M(_____) Y(_________)_______________________________
 
Telephone
Numbers:
Home: (___)_____________________________________________
  Business: (___)___________________________________________
E-Mail Address:___________________________________________________________
Occupation:______________________________________________________________
 
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.
 
Signed:__________________________________________________________________

Date:____________________________________________________________________

 
If the applicant is a junior (ie. under 18 years of age) we require a Parent or Guardian's authorisation:

Parent/Guardians Name:_____________________________________________

Signature:________________________________________________________

Note: If the applicant is under 12 years of age we require a Parent or Guardian to be in attendance at all times.

 
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:
________________________________________________________________________
________________________________________________________________________
Administration use only
 
Received Date:____________________________________________________________
Amount Paid:_____________________________________________________________
Treasurer:______________________________Date:_____________________________