BOOK TODAYPlease complete the details below and a member of our team will contact you to finalise your booking. Venue * Which session would you like to book for? --- Somerset House - First Skills Rondebosch - First Skills St George's Grammar School - Performance Academy Newberry House - Performance Academy Somerset House - Performance Academy Rondebosch - Performance Academy Newberry House Holiday Clinic - 25, 26, 27 September '24 PARENT'S DETAILS * First Name Last Name Email * Phone * (###) ### #### PLAYER'S DETAILS * First Name Last Name Current School * At which school is your child currently registered? Current Grade * What grade is your child currently completing? Date of birth * MM DD YYYY MEDICAL DETAILS Medical Aid Society If none please state PRIVATE Medical Aid Number Medical Aid Main Member INDEMNITY & CONSENT Please read carefully and select the relevant option * I hereby consent to Coerver® South Africa and any of its commercial partners recording, retaining and reproducing my child’s image and voice by way of photographs, sound recordings and video. I further agree to the condition that, while every precaution will be taken for the safety and welfare of my child and for the care of his/her possessions, I will hold blameless and indemnify all persons, Coerver® South Africa and all other organisations associated with the activity, should any prejudice, loss, damage, illness or injury occur to my child during the above activity. This includes an indemnity against recovery of costs resulting from damage, loss and/or medical conditions or hospitalisation, unless such loss is caused by the negligence, wilfulness or deliberate act of Coerver® South Africa or one or more of its employees. I furthermore appoint the Coerver® South Africa staff supervising the activity to act in loco parentis in respect of my child should the need therefore arise. --- Yes, I accept No, I don't accept Thank you for your interest in Coerver® South Africa.A member of our team will contact you to confirm your booking.Alternatively, feel free to contact us with any questions:Robyn Johannes(e) capetown@coerver.co.za(m) 072 217 3916
