Face to Face - 6 week Intensive Cardiac and Diabetes Program at Vector Health Expression of Interest Form

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Attendee First Name: Mother's Name:
Attendee Last Name: Mother's Email Address:
Mother's Mobile/Cell:
Father's Name:
Email Address: Father's Email Address:
Confirm Email Address: Father's Mobile/Cell:
Sport (if applicable):
How did you hear about us?

Training Dates: From 10-Jul-2017 To 19-Aug-2017

I hereby agree to assume all risks and responsibilities surrounding my (or my child's) participation in the program under the instruction of Vector Health coaches. I understand that similar to all sporting activities, there is a risk of damage to personal property, injury or death which may result from causes beyond the control of, and without fault or negligence of Vector Health, its officers, agents, or employees, during the period of my (or my child's) participation. I understand completely the above agreement and agree to be bound thereby. By registering on our site you agree that we may send you email related to our facilities and programs. We will not provide your details to any other company.

I agree :
Date: 15-Dec-2017
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