Online indemnity form​

Kids Classes

Membership Level
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First Name *
Identity Number *
Birth Date
Password *
Last Name *
Email *
Rank
Confirm Password *
Street Address *
Address Line 2
City *
ZIP / Postal Code *
State / Province / Region *
Cell *
Home Tel
Work Tel

Emergency Contact

Emergency Contact First Name *
Emergency Contact Last Name *
Relationship with Emergency Contact *
Emergency Contact Cell *
Emergency Contact Home Tel
Emergency Contact Work Tel

Health History

Physical disabilities / allergies / illnessess if any

Acceptance

Membership Terms and Conditions *
Click here to read the Membership Terms and Conditions
Assumption of Risk and Waiver of Liability *
Click here to read the Assumption of Risk and Waiver of Liability

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Enquiries:
info@quanwessels.co.za
+27 83 261 4427

 

Guy:
guy@quanwessels.co.za
+27 72 397 3577

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1 Kikuyu Road, Sunninghill, Sandton, Johannesburg, Gauteng, South Africa

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