Name

First Name

Last Name

Phone Number

Nationality

Is your child currently a student at Black Rhino Academy?

Yes

Type of Membership

VIP Membership

Regular Membership

Emergency Contact

Please list one person and their phone number.

Medical Information

Do you have any medical problem of which we should be aware of? i.e. Diabetes, heart condition, high blood pressure.

Please read the following carefully and sign the declaration below.

- You must ‘swipe in’ at reception using your membership card upon arrival. Without your membership card, you will be unable to use the centre. - If a card is lost, a replacement will be made on receipt of 5,000/= to cover our administrative costs. - Regular Members are restricted to use the sports center on Tuesday, Thursday and Saturday between 6am - 7.30am or 4.30pm - 7pm - To cancel a membership, members must give one month’s written notice. Prepaid memberships are non-refundable. Membership will be automatically canceled if a member does not pay his/her monthly fee on time. By signing this application you declare that you are in good overall health and can exercise without problems.

I confirm that all the answers above are true to the best of my knowledge and I believe I am able to participate in exercise at Black Rhino Sports Centre.