Sports Registration - Modern Minds Academy

Student's First Name

Student's Last Name

Student's Date of Birth

Allergies (include allergies to medication)

Existing medical conditions

Parent's First Name

Parent's Last Name

Contact number [format: 868xxxxxxx}

Residential Address

Verification: please attach one form of photo ID [ID card, Driver's Permit or Passport]. Upload in jpg, png or pdf. This is to confirm the information entered is accurate.

Select location/s

Princes Town - Buen Intento Recreational Ground San Fernando - Novel Sports Indoor Facility Rio Claro - Rio Claro Recreational Ground

Sport

Cricket Football

Emergency Contact

Relationship to the student

Contact number

Preferred method of payment

PAYMENT AGREEMENT: This agreement constitutes the payee understands payments are to be made within the first week of each month. If a maximum of four weeks passes without payment being made, the payee understands this will result in the removal of the student from the sessions and the Academy reserves the right to obtain funds owed via a third party debt collector.

Yes, I have read and understood the above agreement. I agree to the conditions outlined.

WHOLE AGREEMENT: This agreement constitutes the entire understanding between both parties that fees paid to book a place at the academy is NON-REFUNDABLE, if the student or parent cancels , the coach nor the Academy is responsible and payments must be made in full.

Yes, I have read and understood this agreement. I agree to the terms and conditions outlined.

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You have successfully completed our registration form!