| 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:
________________________________________________________________________
________________________________________________________________________ |