Free Taster Session

Personal Information

First Name *

Last Name *

Email Address *

Date of Birth *

Age *

Address *

Town / City *

Postcode *

Landline Telephone Number *

Mobile Telephone Number *

Emergency Contact Details

Emergency Contact Name *

Relationship To You *

Their Telephone Number *

Doctor’s Name *

Surgery Address *

Surgery Telephone Number *

Confirm

In the event of an accident or illness whilst Training, I hereby give permission for BTBMF to initiate medical treatment and to inform the person named as my emergency contact if appropriate.

To the best of my knowledge I confirm that the information I have provided in this medical questionnaire is a true and accurate description of my medical history and any current condition. I understand that BTBMF reserve the right at any time to prevent participation in the Training if BTBMF consider such action necessary for my own safety.

I understand that BTBMF cannot accept any liability or expenses resulting from any illness, injury or other untoward occurrence arising from any undisclosed medical condition (other than to the extent that death or personal injury arises as a result of its negligence).

I confirm that I will immediately inform BTBMF of any change to the information I have provided.

I have read and understood the Conditions of Participation.

Personal Information

Date of Lesson

Emergency Contact Details

Medical History

Confirm