Please mark corresponding boxes if you have ever had, or currently have:
Other Symptoms / Conditions:
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Please check all appropriate boxes regarding Covid:
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Confirmation of Information
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I acknowledge that I have read this questionnaire in its entirety and have responded accurately, completely, and to the best of my knowledge. If my health status changes at any time, I understand that I am responsible to inform the Franchisee of Run/Walk For Life of any such changes
Indemnity Form
I, the undersigned, indemnify RUN/WALK FOR LIFE SA (PTY) LTD and any of its assistants or employees or its franchisees; assistants or employees from any liability for illness, injury or accident arising from my participation in any of the activities of the RUN/WALK FOR LIFE SA (PTY) LTD programme. I accept that RUN/WALK FOR LIFE SA (PTY) LTD will not be liable to refund membership fees for any reason whatsoever. I declare that all information supplied, including my medical history on the reverse of this form, is true and correct. I acknowledge that I have read this questionnaire in its entirety and have responded accurately, completely, and to the best of my knowledge. If my health status changes at any time, I understand that I am responsible to inform the Franchisee of Run/Walk For Life of any such changes
Signature
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You have successfully registered to become a member of Run Walk For Life.
Please proceed to payment to finalize your membership.
