SEAL PUPS REGISTRATION
Personal Details
Child's Name
Surname
Date of birth
Date
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Sex
Male
Female
Address
Postcode
Email
Confirm Email
Password
Confirm password
Contact Number
Class/Year
School
Parent's Name
Parent's Contact Number
Is there anything you want to tell us about your child?
How Did You Hear About Us?
Enrollment Details
State
Select State
Selangor
Kuala Lumpur
Penang
Course Location
Course Commencement Date
Course Fees
EACH NEW RECRUIT RECEIVES A FREE ORIGINAL BOOTCAMP T-SHIRT UPON ENROLMENT. Please select your size.
T-Shirt Size
Small
Medium
Large
Extra-Large
XX-Large
XXX-Large
Payment Method
Cash
By Cheque
Bank Transfer
Medical/Health Form Pre-Exercise Questionaire
Any major illnesses or disabilities?
Is your child presently exercising?
Yes
No
Brief outline
Has your child been hospitalised recently?
Yes
No
Does your child suffer from any of the following?
Heart disease
Yes
No
Asthma
Yes
No
Heart Condition
Yes
No
Diabetes
Yes
No
Back pain
Yes
No
Epilepsy
Yes
No
Spinal Injuries
Yes
No
Hernia
Yes
No
Arthritis
Yes
No
Heart Palpitations
Yes
No
Joint pains
Yes
No
Hi/low Blood Pressure
Yes
No
Tightness in Chest
Yes
No
Rheumatic Fever
Yes
No
Liver/Kidney Condition
Yes
No
Regular Headaches
Yes
No
Infections
Yes
No
Muscular pain/cramps
Yes
No
Chronic Cough
Yes
No
High Cholesterol
Yes
No
Bladder Weakness?
Yes
No
Allergies to Grass?
Yes
No
Are there any conditions that may limit your physical activity?
Yes
No
Comments
Yes, details above reflect my current medical & health condition
Security Code
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I have read and agree to the
Terms and Conditions
and
Attendance Agreement
All prices are in $RM and include all applicable taxes.
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Notification
The class that you have selected is full, however you may be able to manually enrol if you fill up the following details and an instructor will contact you shortly. Alternatively you may select another class.
First Name
Last Name
Email address
Contact no
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