Jacques Brink Cycling Academy Enrolment Form
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……………………………………………………………..