2019 Canberra Club Enrolment form
All members must complete the enrolment form to participate in classes
Member's First Name *
Your answer
Member's Surname *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Parent/Guardian Contact Name (if under 16 years)
Your answer
Contact email address *
Your answer
Address *
Your answer
Contact Phone Number *
Your answer
Alternative Phone Number
Your answer
Vikings Membership Number
Your answer
I have/My child has an injury/health issue or allergy *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service