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Jacques Brink Cycling Academy Enrolment Formjb-cycling

NAME…………………………………………………………………………..AGE……………

PARENTS NAME …………………………………………….CELL…………………………

EMAIL……………………………………………………………………………………………….

MEDICAL AID NAME & NO………………………………………………………………….

                                            ALLERGIES YES/NO………………………………………………………………………….

SESSIONS PURCHASED  :   single lesson    @ R90       …..

                                            : 8 week package @ R600     …..   …..    …..     …..     …..     …..     …..     …..     …..     …..

NO HELMET – NO RIDE !  INDEMNITY: I recognize the activity I am enrolling my child in involves a risk of injury. I waive and release any claims for injury or damages resulting from this activity and future sessions and agree to hold harmless the organizers/parents for an injury or damage suffered by me or my child while participating. Parent/Guardian………………………………………….. Date……………………………………………………………..

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