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Register With Us

Pro-Path Performance Sign-Up Form

PLAYER INFORMATION

First Name

Last Name

Age

Date of Birth

Address

Address Line 1

Address Line 2

City

Province

Zip Code

Country

PARENT / GUARDIAN DETAILS

First Name

Last Name

Contact Number

EMERGENCY CONTACT

First Name

Last Name

Contact number

Relation to Player

ATTENDANCE CONFIRMATION

Will you be joining?

Yes

MEDICAL INFORMATION

Any medical conditions or allergies?

Yes

If yes, please specify

Medication required?

Yes

Medication details (if applicable)

Programme Fee – R500 per Month

Bank: FNB / RMB
Account Holder: Propathperformance (Pty) Ltd
Account Type: Gold Business Account
Account Number: 631 807 248 67
Branch Code: 250655

Reference: Student Name & Surname

CONSENT, INDEMNITY & MEDIA PERMISSION

I, the undersigned parent/guardian, give permission for my child to participate in the Pro-Path Performance programme.
I understand that participation is at my child’s own risk and consent to basic first aid treatment if required.

I further give permission for photographs and/or video recordings of my child to be used by Pro-Path Performance
for marketing, promotional, and communication purposes.

I agree to the above terms and conditions

Parent First Name

Parent Last Name

Contact Us Today

Email: Pro-Path-Performance@outlook.com