BOOK YOUR FREE TRIALPlease complete the details below and a member of our team will contact you to confirm your booking. Select Your Session * Please select the session that you would like to book for. --- Cornwall Hill College - Monday Cornwall Hill College - Wednesday Cornwall Hill College - Thursday Trinity House Heritage Hill - Thursday Tygervalley College - Friday PARENT'S DETAILS * First Name Last Name Email * Phone * (###) ### #### PLAYER'S DETAILS * First Name Last Name Date of birth * MM DD YYYY Current School * Current Grade * --- Grade 000 Grade 00 Grade 0 Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Current Class * Please tell us which class your child is currently in, as to assist us when collecting them. (Where required) Aftercare Please advise if we should return your child to Aftercare after the session? (Where required) --- Yes please No thanks Not applicable MEDICAL DETAILS Medical Aid Society * If you do not currently make use of a Medical Aid please type PRIVATE. Medical Aid Number Medical Aid Main Member Medical History Is there any medical condition/history that we need to be aware of? INDEMNITY & CONSENT Please read carefully and select the relevant option * I hereby consent to Coerver® South Africa recording, retaining and reproducing my child’s image and voice by way of photographs, sound recordings and video for the purpose of communicating same on requisite closed groups which I have opted into. 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 Thank you for your interest in Coerver® South Africa.A member of our team will contact you to confirm your booking.
