Ladies Coaching Day Clinic Form

Athlete Information

Participant's Name

First NameLast Name

Birth Date

MonthDayYear

Handicap (if non please put N/A)

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Number

Format: (000) 000-0000.

Cell Number

Format: (000) 000-0000.

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Format: (000) 000-0000.

Alt. Phone Number

Format: (000) 000-0000.

Does the participant have any allergies, chronic illness, or medical conditions? If yes, please describe.

ANY SPECIAL DIETARY REQUIREMENTS (please let us know below)

Informed Consent and Acknowledgement I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Rutland Polo Club Ltd . and all its respective officers, agents, and representatives from any and all liability for injuries arising out of participating in, the aforementioned coaching clinic. In case of injury, I hereby waive all claims against Rutland Polo Club Ltd . including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including polo. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

My Products

Full day clinic

£135.00 Quantity

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Total

£0.00

Ladies Coaching Day Clinic booking form