ANZIG Workshops – Expression of Interest Only

Full Name *

Email *

Phone Number *

Age Group
18 months and under2 – 9 years10 – 13 yearsOpen age (Adults, Teenagers, Seniors, etc.)

Registration - I confirm that the information I have supplied in this form for the ANZ Ismaili Games is true and accurate and I understand that any incomplete or misleading information to ANZIG may affect the Participant's registration . Should the participant require emergency medical treatment, I also understand that any incomplete or misleading medical information will affect the medical treatment administered to the participant. I understand that I am obliged to correct and update any personal and medical information where it has changed, and I accept full responsibility for any loss or injury resulting from the reliance upon any old or inaccurate information that I provide.
Medical - In the event of a medical emergency, I hereby authorise emergency treatment to be administered by a qualified staff member. I also give permission to allow to be transported by ambulance to an emergency centre or hospital if needed. I further accept responsibility for all expenses incurred for the medical treatment in case of an emergency.
Release - I release, indemnify and hold harmless Social Development Inc, including His Highness Prince Aga Khan Shia Imami Ismaili Council for Australia and New Zealand, its portfolios, members, staff, volunteers and agents (including the AKYSB and Workshop Team Members) from all liability, claim or expense, however arising, in anyway connected to the Participant’s involvement with the Workshop.