Participant Form

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

General Information

Name

Surname

ID / Passport Number

Mobile Number

Medical Information

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

Yes

Do any of you have any Allergies?

Yes

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:

Terms and Conditions

I declare that the info I’ve provided is accurate & complete

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

I accept the Waiver, Release of Liability, Indemnification and ConsentView here

I hereby confirm that I have read and fully understand the content of this form and all its content and accept on the Father and Sons behalf.View all terms & Conditions

Date*

Your Signature*

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