PARTICIPANT

Full name*

MaleFemalePrefer not to say

Age *

Medical conditions

SELECT THE PROGRAM AND TRAINING DAY/TIME:

ENTRY. Sat. 7:30 - 9:00 amPRIME. Thurs. 6:30 - 8:00 pmPRIME. Sat. 7:30 - 9:00 amSOCIAL. Wed. 7:00 - 8:00 pm

Comments

PARENT / GARDIAN

Full name *

Contact number *

Contact email (for invoices and communication) *

Address

HOW DID YOU HEAR ABOUT CROSSWIM^®: *

I am returning participantSearch engine (e.g. Google)Paper advertising (e.g. flyer)Social media (e.g. Facebook)Word of MouthSignageOther

REFERRALS / I was referred by ( Full Name of the participant or parent/gardian ):

I confirm, that I and/or my child meet the level's entry requirements

I have read, understand and agree with:
Assumption of risks and waiver/release of liabilityTerms and Conditions of the enrolment

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