The Middle Eight Registration

First Name

Last Name

Phone *

Date of birth

Emergency Contact Name, Relation & Mobile number *

Do you have any injuries or medical conditions that may affect your participation? *

Yes

Please provide details of any relevant medical conditions below or type N/A *

Are you currently under medical advice to limit physical activity? *

Yes

Any additional information we should be aware of before you partake in activity with The Middle Eight?

WAIVER and CONSENT *

I confirm that I understand rollerskating and physical training involve a risk of injury. I voluntarily participate at my own risk and accept full responsibility for my health and safety during the session. I confirm that I am fit to take part and have disclosed any relevant medical information. I confirm that the information I have provided is accurate and complete, and I will inform The Middle Eight of any changes that may affect my participation. I understand I may be asked to update my details periodically. I agree that the coach/instructor is not liable for any injury, loss, or damage sustained during participation, except where required by law.

I give permission for photos and videos taken during sessions to be used by The Middle Eight / AuthenticallyKes for promotional and marketing purposes, including social media and online content. I understand I can withdraw this consent at any time by notifying the coach.

Signed

Clear

Date

By checking this box, I consent to receive non-marketing text messages from The Middle Eight / AuthenticallyKes about upcoming skate sessions and events. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

By checking this box, I consent to receive occassional marketing and promotional messages including special offers, discounts, new product updates among others from The Middle Eight / AuthenticallyKes at the phone number provided. Frequency may vary. Message & data rates may apply. Text HELP for assistance, reply STOP to opt out.