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Written by LORY PARK
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Monday, 11 August 2008 06:00 |
APPLICATION / CONSENT / INDEMITY FORM TO ATTEND ABOVE WORKSHOP AT LORY PARK | | |
| Date: | | | Date/s attending | | | Details of Child | | | Surname: | | | First name: | | | Date of Birth | | | Physical Address | | | | | | Home Tel No: | | | | |
| Details of Parent/Guardian: | | | Surname: | | | First Name: | | | Relationship to Child: | | | Home Tel No: | | | Work Tel No: | | | Cell No: | | | E-mail: | | | | | | Emergency Details/Contacts: | | | Person to contact in emergency: | | | Tel No: | | | Known allergies: | | | Other medical conditions: | | | Medical aid membership number: | | | Family Doctor's Tel No: | | | | |
| NOTE: The use of cell phones while on the propery is not allowed during Ranger Days | I ___________________ the parent/guardian of _______________ | | hereby give _________________________ permission to partake in the | | "Be a Ranger for a day" workshop to be held at Lory Park. | | I fully understand that Lory Park will make every attempt to provide a safe environment and provide proper supervision at all times of the workshop. | | However, Lory Park does not accept responsibility for damages, injuries or loss incurred. | | | | ________________________ ________________________ | | (Parent/Guardian Signature) (Parent/Guardian Signature) | | ____/____/__________ date ____/____/________ date |
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Last Updated on Friday, 30 January 2009 15:59 |
