Sprocket Training Enrolment 2017/18

1. Riders Name: *

First

Last

Members to complete to enrol for 2017/18 training. Sprocket training L1 & L2

Level: *

Level 1 (sprocket, new riders)
Level 2 (mid range)

Health & Safety:

Health Concerns
Allergies

Tick box if yes & provide details.

Health & Safety Details:

Health Concerns, Allergies or Dietary Requirements (whether food,insect or other).

Parent/Guardian Details:

Name *

First

Last

Address:

Please provide address details if changed

Phone No:

Mobile No: *

Email *

Confirm Email

Trusted Person Details:

Name: *

First

Last

A trusted person is like a 'next of kin' and is someone a coach can contact in the unlikely event of the Parent/Guardin falling ill or being injured during a training session.

Trusted Persons Contact Numbers: *

Mobile No:

Further details/comments:

Training Concession Card:

Do you have a current training concession card ? *

If yes, please indicate below how many sessions you have left.

Purchase a training concession card:

Training Concession Card (10 sessions) $20

Concession Card can be used for all family members attending training.

Total

$ 0.00

Bank Account 03 0314 0215610 00 Hamilton BMX Club Reference: Surname - Training Once payment is received you will be able to register your attendance for training on the night.

Accept Terms & Conditions: *

By submitting this form you accept the clubs disclaimer, code of conduct & declaration. All riders that have previously held a BMX NZ licence continues to accept the terms & conditions of BMX NZ. Disclaimer: The Hamilton BMX Club Inc accepts no responsibility whatsoever for damage or injury of any nature to any person or property whilst participating in any activity organised by and under its control. Declaration: Privacy Act July 1993. All members need to be aware that the above information has been collected and will only be used for the efficient administration of the club. Details will only be forwarded where the committee sees fit and only after members have been notified, e.g.. for sponsorship purposes. In completing this form the rider/s or in the case of a minor, the parents or representatives of the rider/s, hereby acknowledge that they have read and understood the nature and effect of this disclaimer and declaration.

Signature: *

Please sign using mouse or screen.