Enrolment Form

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Enrolment Form

Name & Surname

Address

Cell phone number

Email address

Date of Birth

Preferred Language

Afrikaans

English

Allergies or medical conditions:

Where did you hear about us?

Herewith I, the undersigned, acknowledge and accept that:

Fees are payable in advance.
Just Africa Scuba cannot accept any liability for loss or injury which may be suffered during attendance.

Consent Form

I grant permission

I do not grant permission

to Just Africa Scuba to take and use photographs and/or digital images of me (excluding names and personal information) for use in printed publications or materials, electronic publications and company website.

Signature

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Date

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Enrolment Form

Enrolment Form

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