Back 2 Basics Academy 2020

Please complete the below Registration Form for
2nd Quarter Classes:
8 May | 15 May | 22 May | 29 May | 5 June | 12 June

(* Required fields)
Applicant Name*

Applicant Surname *

Child or Adult *
ChildAdult

Age (if Child)

Gender *
MaleFemale

Parent Name if applicable

Email *

Cell Phone *

Have you skated before:
YesNo

How did you hear about Back2Basics?

EMERGENCY CONTACT DETAILS
Name *

Contact Number *

Banking Details for EFT (R545 per person) : Cape Peninsula Ice Skating Club, Nedbank Account No: 1075041937 Branch Code: 198765 if paying from Standard Bank add 000 at end of Branch Code i.e. 198765000: Reference Name/Surname B2B :
Please email proof of payment to skateshop@icerink.co.za

ALL PERSONS ENTERING AND/OR UTILISING THESE PREMISES AND/OR ANY FACILITIES, DO SO ENTIRELY AT THEIR OWN RISK AND SHALL HAVE NO CLAIM FOR PERSONAL INJURY OR OF ANY NATURE WHATSOEVER AGAINST THE OWNERS OF THE PREMISES, OR THE CAPE PENINSULA ICE SKATING CLUB, OR ITS FOUNDERS, MANAGEMENT, COMMITTEE OR STAFF, REGARDLESS THAT ANY SUCH CLAIM MAY HAVE ARISEN AS A RESULT OF THE NEGLIGENCE OR GROSS NEGLIGENCE OF THE SAID OWNERS, THE CAPE PENINSULA ICE SKATING CLUB, ITS FOUNDERS, MANAGEMENT, COMMITTEE OR STAFF.
Please leave this field empty.