OPEN DAY - STRAPPING CLINIC SELECTIONS

Don't want to fill out this form online? Click here to download a printable PDF copy of this form

Athlete/Client 1

Load contact details using username and password
If you do not have a username and password, one will be created for you when you submit this form.

Athlete/Client Details

Male Female

Parent/Guardian Details

Address

Health and Fitness

Dates

From 18-May-2019 to 18-May-2019

Days & Times

Once a time slot is full you will be asked to make another choice.

Saturday, 18-May-2019 09:50 AM to 10:20 AM 102 William Street (Vector Health) WRIST
Saturday, 18-May-2019 11:30 AM to 12:00 PM 102 William Street (Vector Health) ANKLE

DISCLAIMER:
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.


Agreement

19-Aug-2019

Media Consent

1)  I, the undersigned, hereby authorize Vector Health to photograph me, take motion pictures of me, take video footage of me, and/or make electronic sound recordings of me (herein referred to as photographic or electronic reproductions).
YES
2)  I authorize the use of any such photographic or electronic reproductions of me for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by Vector Health (I understand that I may be identifiable from such photographic or electronic reproduction)
YES
3)  PARENTAL CONSENT - This applies if you are enrolling a child under the age of 18 years in your care.  I certify that I am the parent or guardian of the individual above who is a minor under the age of eighteen years. I hereby agree to assume legal responsibility for his/her authorizations referred to in this General Media Release. 
YES