Non-Member Waiver 2025

Non-Member Waiver 2025

Non-Members must complete this form prior to using the facility
Athletes Name

First NameLast Name
Contact Mobile Number:
Format: 0000000000.
Contact Email:
example123@example.com
Athletes Birth Date:

DayMonthYear
Athletes Age as of Dec 31 2024
Parent/Guardian/ Emergency Contact Information
Parent or Guardian / Emergency Primary Contact Name

First NameLast Name
Parent or Guardian / Emergency Primary Contact Mobile Number:
Format: 0000000000.
Parent or Guardian / Emergency Primary Contact Email
Athlete Medical Details
Ambulance Cover
Bandaid Allergy
Medical history/Medication or Allergies
If Applicable
Private Health Fund Name & Number
If Applicable
Terms and Conditions & Wavier
Pure Allstars Waiver
Signature
Date Signed

DayMonthYear
Date
Should be Empty:

Parent/Guardian/ Emergency Contact Information