Special Needs Basketball Training

Please fill in this form. If you are registering more than 1 participant, please submit a fresh registration.

Purpose*

Sign up*Trial

Time*

10am - 11am

Participant's Information

Full name*

Full name as per BC/NRIC

Date of Birth*

DayMonthYear

Gender*

MaleFemale

Parent/Guardian's Information

Parent/Guardian's Name*

Only full name will be accepted

Mobile Number*

Only Singapore number is accepted

E-mail*

Emergency Information

Emergency Contact's Name*

Only full name will be accepted

Relationship*

Mobile Number*

Only Singapore number is accepted

Alternate Mobile Number

Only Singapore number is accepted

E-mail

Does the participant have special needs that we should be aware of?*

A 'nil' remark is required if not applicable

Please specify any food and medical allergies. *

A 'nil' remark is required if not applicable

Please specify any previous and current injuries as well as medical history.*

A 'nil' remark is required if not applicable

Is the participant prescribed an inhaler? Please specify instruction. *Participant must bring prescribed inhaler to class.*

A 'nil' remark is required if not applicable

I hereby

Confirmation

BY ACKNOWLEDGING AND SUBMITTING 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.
ABOVE 16 YEARS OLD OR THAT PARENTS/GUARDIAN'S CONSENT HAS BEEN OBTAINED FOR PARTICIPANTS BELOW 16 YEARS OLD.

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