REGISTRATION
Please select any of the following signs or symptoms that you may have recently experienced:
Have you had a medical check-up over the past 6 months which has given you clearance to exercise?
Do you currently have any of the following conditions?
Do you suffer from any allergies?
Please Elaborate
Are you asthmatic?
Are you on a Beta-Blocker?
Have you had any recent flu or flu like symptoms necessitating a doctor's visit in the last 6 weeks?
*How long since you recovered from COVID?
Were you hospitalised?
Please check all appropriate boxes, should you currently suffer from any of the below, as a result of having had COVID:
I hereby acknowledge that I have a membership contract with Run/Walk For Life which is valid and binding for the above period
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
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
Use your mouse or finger to draw your signature
Your application has been received.