Mannering Park Amateur Sailing Club Inc

START SAILING REGISTRATION FORM

Course Details: 14th Ė 19th January 2019 commencing at 9.00am and finishing at 3.00pm each day
Participants Details (please provide a separate form for each entry)
Name
AgeDOB
Parent/Guardian Name
Address
SuburbPostcode
Phone Number
Email Address
Alternative Email Address

Parent/Guardian authority form (to be completed if participants are under 18 year of age)
I (Parent/Guardian)give permission for
Name
to participate in the MPASC Start Sailing 1 & 2 course
Indemnity
Name (please print): (on behalf)
hereby release Mannering Park Amateur Sailing Club Inc. or representative thereof, from any claim or demand that I/we may have or deem to have on my/our behalf arising out of the MPASC Start Sailing 1 & 2 course and indemnify Mannering Park Amateur Sailing Club Inc. or any other representative thereof against any claim that may be made.
 
I understand that photos may be taken during the course and uploaded to the club website. Please advise the Instructor on the day of the course if you donít wish photos to be taken of your child.
 
I agree to be bound by the above Indemnity terms and conditions.
Dated 18/12/18
Please advise health, dietary or cultural issues which you feel are relevant the participantís application
Payment

(Please select your payment option) for the first child $90. For additional children $80

Direct to Bank - Mannering Park Amateur Sailing Club Inc - BSB: 062 832 ACC#: 10225462

(Please use your surname as the payment reference)

Payment Amount
Payment Reference


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