Wellness Centre
TKO Internal Activation
Team Name______
PLAYER 1 / CellD.O.B / Age
Email / Please indicate whether you have any disabilities/family medical history:
Gender / ○ Male ○ Female
Medical Aid Name / Next of Kin
Membership Number / Contact Number
Medical Plan / Signature
PLAYER 2 / Cell
D.O.B / Age
Email / Please indicate whether you have any disabilities/family medical history:
Gender / ○ Male ○ Female
Medical Aid Name / Next of Kin
Membership Number / Contact Number
Medical Plan / Signature
PLAYER 3 / Cell
D.O.B / Age
Email / Please indicate whether you have any disabilities/family medical history:
Gender / ○ Male ○ Female
Medical Aid Name / Next of Kin
Membership Number / Contact Number
Medical Plan / Signature
PLAYER 4 / Cell
D.O.B / Age
Email / Please indicate whether you have any disabilities/family medical history:
Gender / ○ Male ○ Female
Medical Aid Name / Next of Kin
Membership Number / Contact Number
Medical Plan / Signature
PLAYER 5 / Cell
D.O.B / Age
Email / Please indicate whether you have any disabilities/family medical history:
Gender / ○ Male ○ Female
Medical Aid Name / Next of Kin
Membership Number / Contact Number
Medical Plan / Signature
PLAYER 6 / Cell
D.O.B / Age
Email / Please indicate whether you have any disabilities/family medical history:
Gender / ○ Male ○ Female
Medical Aid Name / Next of Kin
Membership Number / Contact Number
Medical Plan / Signature
FACILITY RULES AND REGULATIONS
1. The captain is responsible for his team and must ensure that all players abide by the rules of the game and the referee. Any individuals not adhering to the rules will be asked to leave the field at the discretion of the ref.
2. Arrive on time for timeslot booked. Any late arrivals will result in less playing time.
3. Teams, and players not playing in the good spirit of the game and or not adhering to the rules of the game, will be asked to leave the field and will be banned from any further use of the facility.
4. Drinking, swearing, drugs, weapons, aggression to other players, aggression to the ref will not be tolerated and the team and or players will be banned from any further use of the facility if this conduct occurs. Management will adopt a zero tolerance policy towards any team and players behaving in such a manner.
All the above rules are final and binding and may not be challenged. Titanium Soccer reserves the right to amend or relax any of the above rules as they deem necessary.
Team Captain Signature Date:
______
TKO Soccer Activation Registration
Private and Confidential
Page 2 of 4
Wellness Centre
TKO Internal Activation
TKO Soccer Activation Registration
Private and Confidential
Page 2 of 4