2019/20 Registration

Please list any health or medical conditions, disability or allergy concerns for each member.

Please also note the existing conditions are not covered under our accident insurance policy.
List Member Medical or Health Conditions
Emergency Contact Name
First Last
Relationship to Members
Emergency Contact Phone Number
1.   I agree to abide by the rules, regulations of MLAASC and Warringah ASA Inc.

2.   I authorise MLAASC and Warringah ASA to use or disclose to related and relevant bodies of my personal information that may be necessary to implement the rules, regulations and policies in 1 above.

3.   I Agree to have our names, photograph and results published in programs, newsletters and website.

4.   I authorise MLAASC and Warringah ASA Inc to use or disclose, to related and relevant bodies any of my child’s /Children’s personal information that may be necessary to implement the rules, regulations and policies in 1 above.
Declaration Name
First Last
Declaration Date

DD
MM
YYYY
Total
$ 0.00