RECREATION PROGRAMS ONLINE ENROLMENT FORM

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					                                              RECREATION PROGRAMS
                                             ONLINE ENROLMENT FORM

                          Course Enrolling In                                        Course Date


                                                                                     Course Time


   Please note, all course participants must have a card made for them at Flinders Sport & Fitness. At the time of making this card
   any concession card / proof of ID will be requested prior to you being accepted into the course. Thank you.


 Participant Type


 Surname                                        Given Name                                             Date of Birth


 Address                                                     Suburb                                           Post Code


 Phone Number                                    Mobile Number                                   Male / Female


 Email


 Please note that there are limited positions available in each course, as such registrations are taken on a first come, first served basis
 anyone who registers and pays for a program which fills will be offered a full refund, or the opportunity to take place in a future
 course. This form must be accompanied with full payment. Thank-you.

                                                                 PAYMENT

 Payment Method                                  Credit Card Number


 Expiry Date (mm/yy)                             Credit Card Name


 Payment Total

 CONDITIONS OF ENROLMENT:
 I understand that FUSF and/or employees cannot be held liable for any personal injuries or accidents arising from participation in
 any FUSF course or activity unless the organisation if found to be negligent. Participants ust be physically and mentally capable to
 undertake the activity they involve themselves in. I acknowledge and understand that I make that judgement and that I undertake
 the activities at my own risk.
 I accept that changes to enrolment will only be accepted prior to the close of registration. All programs are not refundable, except
 by the submission of a medical certificate to verify my inability to participate.
 Courses may be cancelled where insufficient numbers are enrolled or where weather conditions are unsuitable. In the event of a
 cancelled course all fees will be fully refunded to paid up participants.
 A completed medical declaration, as found on the accompanying page must accompany this form to complete enrolment. This may
 be printed and brought in, or filled in and completed at Flinders Sport & Fitness prior to beginning the course.



Signed                                               Date                                             Submit by Email