Course Registration Form

Name

First NameLast Name

Age:

Address

Street Address

Street Address Line 2

Suburb

Post Code

Mobile Number

Format: 0000-000-000.

E-mail Adress

example@example.com

These sessions may include physical activity which raises your heart rate and involves twisting, bending, squatting and running. We advise you inform coaches on the day of any injuries or pre-existing medical conditions that may be affected by these movements and physical activity. If you are unsure, then we advise you consult your doctor or heath physician before undertaking the activity. Please list any medical conditions that you would like to remain confidential below, these will be stored in line with the Shire of Donnybrook record keeping plan and council policy ADM/CP-1 Records Management.

Disclaimer

The Shire of Donnybrook-Balingup will not be responsible for any injury suffered by either participant or non-participant members of the group while using facilities: whether the injury be self-inflicted, caused by another member of the group, or caused by another person not associated with the group.

The Shire of Donnybrook Balingup will not be liable in any way for any loss of, or damage to the property of members of the group, whether members or non-members of the group cause the loss or damage.

The above does not apply to the extent that any injury, loss or damage is caused or contributed to by the wilful negligent or other unlawful act or omission of the Shire of Donnybrook Balingup or any of its employees, officers, agents or contractors.

Donnybrook Recreation Centre - Have A Try Day Registration Form