Combat Keystones Registration form

Full Name

Date of Birth

Telephone Number

Email Address

How did you hear about us?

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ICE Name :

Emergency contact, please include a name and if relevant their relationship to you

ICE Number:

Please ensure this number is correct and up to date

PARQ?

Physical activity ready questionairre

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Question 1:

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Question 2

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Question 3

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Question 4

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Question 5

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Question 6

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Question 7

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Question 8

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Question 9

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Question 10

Date Signed

Signature

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