MEL GT Weekly Group Session Registration Form

Select the group session...

Name*

First Last

Age

Address*

Street Address City State / Province / Region ZIP / Postal Code

Parents Name

First Last

Email*

Mobile Phone*

Payment Amount $20

Please use child’s full name as reference for payments. Please bring: water bottle, cap, sunscreen. Spikes optional.
Wet weather: The group session will proceed unless the track is closed. In the case of rain updates will be provided on Melinda's twitter account located on the Home Page of www.melgt.com.au please check the page throughout the day of your session.

Consent

Parents Home Phone*

Parents Mobile Phone*

Parents Work Phone*

Please state any medical history that should be known to staff

How did you hear about us?

Little A's
Attended clinic before
MELGT Clinic Flier
MELGT Website
Friend
Your Sports Club

Sports Club Name

In consideration for participating in the MEL GT Group Sessions run by Mel GT Enterprises Pty Ltd., I agree to do so at my own risk and I accept responsibility for my safety and personal possessions. I acknowledge and understand that the Training Event may be dangerous to the extent that in some circumstances it may endanger my health or the health of others. I agree that I have chosen to participate in the MEL GT Group Session. I agree to disclose any injuries, disabilities, diseases or ailments or other health concerns which may effect my safe participation or ability to safely take part in the MEL GT Group Session. I agree to immediately notify Mel GT Enterprises Pty Ltd on the occurrence of any change in my health or my development of any health concerns. I also agree to abide by any decision that Mel GT Enterprises Pty Ltd may make in relation to my continued participation in the MEL GT Group Session. I release, indemnify, continue to indemnify and hold harmless Mel GT Enterprises Pty Ltd, its directors, staff, or agents from all and any responsibility or liability for any losses, damages, claims, actions, costs, expenses or liabilities whatsoever suffered or incurred by me arising out of my participation in the MEL GT Group Session. I ACKNOWLEDGE that I participate in the MEL GT Groups Session of my own free will and that I have read and understood the conditions above.

Your Consent*

I agree

Signature

Email

This field is for validation purposes and should be left unchanged.

GROUP SESSIONS REGISTRATION FORM

Consent