Child / Adolescent details
Name:
Age:
Date of Birth:
Gender:
Male
Female
Weight (approx):
Kg
Height (approx)
cm
Contact Details:
Home Address:
Ph (Preferred):
Ph (Alternate):
Email:
Are you aware, through your own experience or your Doctor’s advice, of any other reason why your child/ adolescent should not exercise without medical approval?
How did you hear about us?
“Mens Sana Mens Corpa”
Healthy Mind Healthy Body
