FUNDRAISING FOR COACH JONTY SQUASH “DEURNAG” REGISTRATION FORM 19/20 OCTOBER 2018 Player informationName and Surname of player*E-mail address* Date of Birth* Player Cell PhoneMother's Name and Surname*Mother's cell phone*Father's Name and Surname*Father's cell phone*Name of School*Grade*Pre SchoolGr RGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade8Grade 9Grade 10Grade 11Grade 12Home Address*Friend/Family Name and Surname*Friend/Family phone*Cost*R300 to be paid before or on 15 October 2018 If not possible please email to make arrangementsMedical informationPrincipal member of medical aid*Medical aid provider*Medical aid number*Illnesses and/or allergies*Agreement*I hereby give consent for my child to take part in the CJS “DEURNAG” and related activities on 19/20 Oct 2018. I hereby appoint and authorise the coaches in charge to act in loco parentis and if necessary give consent to my child undergoing medical treatment. I undertake to pay for the cost of such treatment, when required. I fully understand and accept that all activities are undertaken at my child’s own risk. I am also aware that Centurion Junior Squash and Uitsig Club accepts no responsibility for any loss, injury or damage to the person or property of my child which may be sustained whilst engaged in the above activity. I waive any right that I and, in so far as I am able, and my child may have to claim compensation against Centurion Junior Squash or any of its coaches or other members, in respect of any loss, injury or damage incurred whilst engaged in the above activity, howsoever arising and whether as a result of negligence or otherwise, and I indemnify them against all claims arising from such activity.