Participant Form

This is the 4MZA Waiver, Release of Liability, Indemnification, and Consent to Medical Attention (Must be completed digitally before participation).

Name*

Surname*

Email*

ID Number*

Mobile Number*

Passport Number

Choose your event*

Are you suffering from a medical condition, illness, or injury?*

Yes

No

Do you have any Allergies?*

Yes

No

If you answered yes to any question or if there is anything you would like the 4M Team to know, Please elaborate:

In Case of Emergency (ICE) Name:*

ICE Phone Number:*

Relation to ICE Person:*

Medical Aid Name:*

Medical Aid Number:*

I declare that the info I've provided is accurate and complete.

I am aware of the challenge and dangers of participating in this event and am physically and mentally able to participate.

I accept the Waiver, Release of Liability, Indemnification and Consent View here

I hereby confirm that I have read and fully understand the content of this form and accept all terms and conditions

Signature*

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Date*

Gift Card

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