Enrolment Form- AMAYDA Intervetion Course
This program is currently going to be run in your school. Below is important information on how to sign up for this amazing after school program that will teach your child how to be more aware of conflict situations and how to manage them in a positive way. Also you child will learn self defence techniques to keep them safe.
School
*
Pallara State School Term 3 Week 1
St Johns Anglican College (Forest Lake) Term 3 Week 1
Mount Warren Park SS Term 3, week 1
Clontarf Beach SHS Term 3, week 1
Bellbird Park State Secondary College Term3, Week 3
School Class Day
Tuesday 3:00pm-4:00pm
Thursday 3:00pm-4:00pm
School Class Day
Tuesday 3:30pm-4:30pm
School Class Day
Wednesday 3:15pm to 4:15pm
School Class Day
Wednesday 3:15pm to 4:15pm
School Class Day
Thursday 3:15pm to 4:15pm
How Many Children
*
Price
Each enrolment is inclusive of Training Gloves.
Total Intervention Cost
*
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( X )
AUD
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Full Name
First Name
Last Name
E-mail
example@example.com
Contact Number
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
I understand the risks include
*
I fully realize the dangers of participating in an activity of this type (Martial Arts) and voluntarily assume all the risks associated with such participation.
I agree that it is our sole responsibility
*
I agree that it is our sole responsibility to be familiar with the physical and mental demands associated with this activity (Martial Arts).
I understand that there may be video photography and/or still images being recorded at this event
*
I hereby release use of said images/video to the facilitators of this event, with no expectation of compensation, monetary or otherwise.
COVID 19 Waiver
*
I acknowledge the contagious nature of the Coronavirus/COVID-19. I voluntarily seek services provided by AMAYDA Pty Ltd and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.
Read
FULL WAIVER
here.
I have READ FULL WAIVER
*
I hereby certify I READ THE FULL WAIVER and acknowledge it.
Submit
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